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1

Intrasphincteric injection of botulinum toxin for suspected sphincter of Oddi dysfunction.  

PubMed Central

Botulinum toxin is a potent inhibitor of the release of acetylcholine from nerve endings. It has previously been shown that it can effectively reduce lower oesophageal sphincter pressures both in animals and humans with achalasia. This study examined the hypothesis that locally injected botulinum toxin could also reduce sphincter of Oddi pressure in patients with sphincter of Oddi dysfunction. Two patients with postcholecystectomy pain syndrome were diagnosed with sphincter of Oddi dysfunction (by biliary manometry in one patient and by hepatobiliary scanning criteria in the other). Botulinum toxin was injected into the sphincter of Oddi, by a sclerotherapy needle passed through a duodenoscope. In the first patient, intrasphincteric injection of botulinum toxin reduced sphincter pressure by about 50%, an effect that was sustained for at least four months. In the second patient, intrasphincteric injection caused about a 50% improvement in bile flow, with normalisation of scintigraphy. Neither patient showed any sustained improvement in pain despite these objective findings. Both patients eventually had endoscopic sphincterotomy, which also did not result in symptomatic improvement in either patient. No side effects were seen. Intrasphincteric botulinum toxin is a simple and effective means of lowering sphincter of Oddi pressure. This technique has potential for being useful clinically. PMID:7959245

Pasricha, P J; Miskovsky, E P; Kalloo, A N

1994-01-01

2

Describing a new syndrome in L5-S1 disc herniation: Sexual and sphincter dysfunction without pain and muscle weakness  

PubMed Central

Context: Little seems to be known about the sexual dysfunction (SD) in lumbar intervertebral disc herniation. Aims: Investigation of sexual and sphincter dysfunction in patient with lumbar disc hernitions. Settings and Design: A retrospective analysis. Materials and Methods: Sexual and sphincter dysfunction in patients admitted with lumbar disc herniations between September 2012-March 2014. Statistical Analysis Used: Statistical analysis was performed using the Predictive Analytics SoftWare (PASW) Statistics 18.0 for Windows (Statistical Package for the Social Sciences, SPSS Inc., Chicago, Illinois). The statistical significance was set at P < 0.05. The Wilcoxon signed ranks test was used to evaluate the difference between patients. Results: Four patients with sexual and sphincter dysfunction were found, including two women and two men, aged between 20 and 52 years. All of them admitted without low back pain. In addition, on neurological examination, reflex and motor deficit were not found. However, almost all patients had perianal sensory deficit and sexual and sphincter dysfunction. Magnetic resonance imaging (MRI) of three patients displayed a large extruded disc fragment at L5-S1 level on the left side. In fourth patient, there were not prominent disc herniations. There was not statistically significant difference between pre-operative and post-operative sexual function, anal-urethral sphincter function, and perianal sensation score. A syndrome in L5-S1 disc herniation with sexual and sphincter dysfunction without pain and muscle weakness was noted. We think that it is crucial for neurosurgeons to early realise that paralysis of the sphincter and sexual dysfunction are possible in patients with lumbar L5-S1 disc disease. Conclusion: A syndrome with perianal sensory deficit, paralysis of the sphincter, and sexual dysfunction may occur in patients with lumbar L5-S1 disc disease. The improvement of perianal sensory deficit after surgery was counteracted by a trend toward disturbed sexual function. Further researches are needed to explore the extent of this problem.

Akca, Nezih; Ozdemir, Bulent; Kanat, Ayhan; Batcik, Osman Ersagun; Yazar, Ugur; Zorba, Orhan Unal

2014-01-01

3

Spinal Cord Stimulation for Intractable Visceral Pain Due to Sphincter of Oddi Dysfunction  

PubMed Central

Sphincter of Oddi dysfunction (SOD) is a syndrome of chronic biliary pain or recurrent pancreatitis due to the functional obstruction of the pancreaticobiliary flow. We report a case of spinal cord stimulation (SCS) for chronic abdominal pain due to SOD. The patient had a history of cholecystectomy and had suffered from chronic right upper quadrant abdominal pain. The patient had been diagnosed as having SOD. The patient was treated with opioid analgesics and nerve blocks, including a splanchnic nerve block. However, two years later, the pain became intractable. We implanted percutaneous SCS at the T5-7 level for this patient. Visual analog scale (VAS) scores for pain and the amount of opioid intake decreased. The patient was tracked for more than six months without significant complications. From our clinical case, SCS is an effective and alternative treatment option for SOD. Further studies and long-term follow-up are necessary to understand the effectiveness and the limitations of SCS on SOD. PMID:25589948

Lee, Kang Hun; Lee, Sang Eun; Jung, Jae Wook

2015-01-01

4

Abnormal electromyographic activity of the urethral sphincter, voiding dysfunction, and polycystic ovaries: a new syndrome?  

Microsoft Academic Search

A potential association between abnormal electromyographic activity--that is, decelerating bursts and complex repetitive discharges--of the urethral sphincter and difficulty in voiding was examined in 57 women with urinary retention. Abnormal electromyographic activity was found in 33. Ultrasonography of the ovaries in 22 of the 33 women showed that 14 had polycystic ovaries. Of the other eight women, two had had

C. J. Fowler; T. J. Christmas; C. R. Chapple; H. F. Parkhouse; R. S. Kirby; H. S. Jacobs

1988-01-01

5

Sphincter of Oddi dysfunction: Psychosocial distress correlates with manometric dyskinesia but not stenosis  

Microsoft Academic Search

AIM: To compare postcholecystectomy patients with Sphincter of Oddi (SO) dyskinesia and those with nor- mal SO motility to determine the psychosocial distress, gender and objective clinical correlates of dyskinesia, and contrast these findings with comparisons between SO stenosis and normal SO motility. METHODS: Within a cohort of seventy-two consecutive postcholecystectomy patients with suspected SO dys- function, manometric assessment identified

Ethelle Bennett; Peter Evans; John Dowsett; John Kellow

2009-01-01

6

Videofluoroscopy-Guided Balloon Dilatation for the Opening Dysfunction of Upper Esophageal Sphincter by Postoperative Vagus Nerve Injury: A Report on Two Cases  

PubMed Central

Dysphagia secondary to peripheral cranial nerve injury originates from weak and uncoordinated contraction-relaxation of cricopharyngeal muscle. We report on two patients who suffered vagus nerve injury during surgery and showed sudden dysphagia by opening dysfunction of upper esophageal sphincter (UES). Videofluoroscopy-guided balloon dilatation of UES was performed. We confirmed an early improvement of the opening dysfunctions of UES, although other neurologic symptoms persisted. While we did not have a proper comparison of cases, the videofluoroscopy-guided balloon dilatation of UES is thought to be helpful for the early recovery of dysphagia caused by postoperative vagus nerve injury. PMID:24639936

Jung, Bora; Choi, Ikjun; Lee, Nam Jae; Jung, Kwang-Ik; Yoo, Woo-Kyoung

2014-01-01

7

Sphincter of Oddi Dysfunction  

MedlinePLUS

... or imaging (blood test, ultrasound, CT scan, or MRCP) to suggest a definite abnormality, such as a stone in the bile duct. MRCP (magnetic resonance cholangiopancreatography) is nowadays a good non- ...

8

Modulation of the Lobster Pyloric Rhythm by the Peptide Proctolin  

Microsoft Academic Search

The modulation of the pyloric network of the stomatogastric ganglion (STG) of the lobster Panulirus interruptus by the neuropeptide proctolin is described. First, the effects of proctolin on the pyloric motor patterns were characterized in terms of frequency and phase rela- tions. Pyloric cycle frequency and lateral pyloric (LP) neuron activity increased and ventricular dilator (VD) neuron activity decreased with

Scott L. Hoopera; Eve Marder

1987-01-01

9

THE FUNCTIONAL ROLES OF THE LATERAL PYLORIC AND VENTRICULAR DILATOR NEURONS IN THE PYLORIC NETWORK OF THE LOBSTER,  

E-print Network

OF THE LOBSTER, Panulirus interruptus. A dissertation presented to the faculty of the College of Arts AND VENTRICULAR DILATOR NEURONS IN THE PYLORIC NETWORK OF THE LOBSTER, Panulirus interruptus. BY ADAM L. WEAVER roles of the Lateral Pyloric and Ventricular Dilator neurons in the pyloric network of the lobster

Weaver, Adam Lee

10

An instant rare complication: a fractured metallic pyloric stent  

PubMed Central

Metallic pyloric stenting (also termed as metallic enteral stenting) performed endoscopically, stands as first-line treatment for malignant gastric outlet obstruction. With reported evidence, these self-expandable metallic stents (SEMS) re-enable oral food intake, preventing patients having to face invasive techniques such as surgical gastroenterostomy. We report a patient having received a covered pyloric SEMS insertion following a tumour growth causing stenosis in the gastric antropyloric region. After 3?weeks, the patient presented with a fracture of the pyloric SEMS, a rare complication, resulting in a second pyloric SEMS insertion. PMID:23345482

Javaid, Mahvesh Rana; Yusuf, Aasim Mohammad

2013-01-01

11

[Stretch sphincter of the esophagus : Paradoxical sphincter with angiomyoelastic architecture.  

PubMed

The investigations described in this article clearly show that the lower esophageal sphincter (LES) represents a variation of circular muscular occlusive mechanisms found elsewhere in the gastrointestinal tract. The LES is a double layer stretch sphincter that operates in an apparently paradoxical manner: it closes when under stretch but opens when the muscle fibers contract. Impedance manometry studies demonstrate that the entire esophagus is involved in the normal functioning of the esophagus as well as in esophageal disorders. The pronounced elasticity of esophageal tissue is a functional feature that has its basis in the singular architecture of elastic fibers located between the muscle layers. All traditional forms of operative treatment of gastroesophageal reflux disease (GERD) impede the natural functioning of the stretch sphincter to a greater or lesser degree by locking it up. The cause of GERD is mainly by contraction of the esophagus brought about by the cephalad transposition of the stretch sphincter segment into the chest. In a sense this is an incipient axial hernia that frequently remains undiagnosed in the early stages. The operative repositioning of the stretch sphincter segment into the abdominal cavity provides sufficient restoration of the natural topographic relationships to achieve a cure of GERD. Whether this straightforward repair restores the function of the entire esophagus remains to be elucidated. The concept of the stretch provides a good explanation of the pathophysiology of achalasia, a condition in which a paralyzed paradoxical ring sphincter remains occluded. Successful myotomy approaches only split the muscularis propria layer of the stretch sphincter while leaving subepithelial muscle fibers intact that remain paralyzed. This limited intervention provides a good relief of symptoms. PMID:25204425

Stelzner, F

2014-09-11

12

Physiological and Functional Evaluation of the Transposed Human Pylorus as a Distal Sphincter  

PubMed Central

Background/Aims Studies evaluating the human pylorus as a sphincter are scanty and contradictory. Recently, we have shown technical feasibility of transposing the human pylorus for end-stage fecal incontinence. This unique cohort of patients provided us an opportunity to study the sphincter properties of the pylorus in its ectopic position. Methods Antro-pylorus transposition on end sigmoid colostomies (n = 3) and in the perineum (n = 15) was performed for various indications. Antro-pylorus was assessed functionally (digital examination, high resolution spatiotemporal manometry, barium retention studies and colonoscopy) and by imaging (doppler ultrasound, MRI and CT angiography) in its ectopic position. Results The median resting pressure of pylorus on colostomy was 30 mmHg (range 28-38). In benign group, median resting pressure in perineum was 12.5 mmHg (range 6-44) that increased to 21.5 mmHg (range 12-29) (P = 0.481) and 31 mmHg (range 16-77) (P = 0.034) on first and second follow-up, respectively. In malignant group, median post-operative pressures were 20 mmHg (range 14-36) and 21 mmHg (range 18-44) on first and second follow-up, respectively. A definite tone and gripping sensation were felt in all the patients on digital examination. On distal loopogram, performed through the diverting colostomies, barium was retained proximal to the neo-pyloric valve. Both perineal ultrasound and MRI showed viable transposed graft. CT angiography and color doppler studies confirmed vascular flow in the transposed position. Conclusions The human pyloric valve can function as a tonic sphincter when removed from the gastroduodenal continuity. PMID:22837874

Ghoshal, Uday C; Gupta, Vishal; Jauhari, Ramendra; Srivastava, Rajendra N; Misra, Asha; Kumar, Ashok; Kumar, Manoj

2012-01-01

13

Genetics Home Reference: Epidermolysis bullosa with pyloric atresia  

MedlinePLUS

... Patients and Families Resources for Health Professionals What glossary definitions help with understanding epidermolysis bullosa with pyloric ... many other terms in the Genetics Home Reference Glossary . See also Understanding Medical Terminology . References (7 links) ...

14

Vagal Afferent Innervation of the Lower Esophageal Sphincter  

PubMed Central

To supply a fuller morphological characterization of the vagal afferents innervating the lower esophageal sphincter (LES), specifically to label vagal terminals in the tissues forming the LES in the gastroesophageal junction, the present experiment employed injections of dextran biotin into the nodose ganglia of rats. Four types of vagal afferents innervated the LES. Clasp and sling muscle fibers were directly and prominently innervated by intramuscular arrays (IMAs). Individual IMA terminals subtended about 16° of arc of the esophageal circumference, and, collectively, the terminal fields were distributed within the muscle ring to establish a 360° annulus of mechanoreceptors in the sphincter wall. 3D morphometry of the terminals established that, compared to sling muscle IMAs, clasp muscle IMAs had more extensive arbors and larger receptive fields. In addition, at the cardia, local myenteric ganglia between smooth muscle sheets and striated muscle bundles were innervated by intraganglionic laminar endings (IGLEs), in a pattern similar to the innervation of the myenteric plexus throughout the stomach and esophagus. Finally, as previously described, the principle bundle of sling muscle fibers that links LES sphincter tissue to the antropyloric region of the lesser curvature was innervated by exceptionally long IMAs as well as by unique web ending specializations at the distal attachment of the bundle. Overall, the specialized varieties of densely distributed vagal afferents innervating the LES underscore the conclusion that these sensory projections are critically involved in generating LES reflexes and may be promising targets for managing esophageal dysfunctions. PMID:23583280

Powley, Terry L.; Baronowsky, Elizabeth A.; Gilbert, Jared M.; Hudson, Cherie N.; Martin, Felecia N.; Mason, Jacqueline K.; McAdams, Jennifer L.; Phillips, Robert J.

2013-01-01

15

Videourodynamic and sphincter motor unit potential analyses in Parkinson's disease and multiple system atrophy  

PubMed Central

OBJECTIVES—Urinary dysfunction is a prominent autonomic feature in Parkinson's disease (PD) and multiple system atrophy (MSA), which is not only troublesome but also a cause of morbidity in these disorders. Recent advances in investigative uroneurology offer a better insight into the underlying pathophysiology and appropriate management for urinary dysfunction.?METHODS—twenty one patients with PD (15 men, six women, mean age 64 (49-76), mean disease duration 4 years (1-8 years), median Hoehn and Yahr grade 3 (1-4), all taking 300 mg/day of levodopa (100-500 mg)) and 15 with MSA (eight men, seven women, mean age 59 (48-72), mean disease duration 3 years (0.5-6 years)) were recruited. Videourodynamic and sphincter motor unit potential analyses in the patients with PD and MSA were carried out, looking for distinguishing hallmarks that might be useful in the differential diagnosis of these two diseases.?RESULTS—Urinary symptoms were found in 72% of patients with PD and in 100% with MSA. Filling phase abnormalities in the videourodynamic study included detrusor hyperreflexia in 81% of patients with PD and 56% with MSA, and uninhibited external sphincter relaxation in 33% of patients with PD and 33% of those with MSA. However, open bladder neck at the start of filling was not seen in patients with PD but was present in 53% of those with MSA, suggestive of internal sphincter denervation. Sphincter motor unit potential analysis showed neurogenic motor unit potentials in 5% of patients with PD and in 93% of those with MSA, suggestive of external sphincter denervation. On voiding, detrusor-external sphincter dyssynergia was not seen in patients with PD but was present in 47% of those with MSA. Pressure-flow analysis showed that the Abrams-Griffiths number, a grading of urethral obstruction (outflow obstruction >40), in PD (40 in women and 43 in men) was larger than that in MSA (12 in women and 28 in men). Weak detrusor in PD (66% of women and 40% of men) was less common than that in MSA (71% of women and 63% of men). Postmicturition residuals >100 ml were absent in patients with PD but were present in 47% of patients with MSA.?CONCLUSION—Patients with PD had less severe urinary dysfunction with little evidence of internal or external sphincter denervation, by contrast with the common findings in MSA. The findings of postmicturition residuals >100 ml, detrusor-external sphincter dyssynergia, open bladder neck at the start of bladder filling, and neurogenic sphincter motor unit potentials are highly suggestive of MSA.?? PMID:11606669

Sakakibara, R; Hattori, T; Uchiyama, T; Yamanishi, T

2001-01-01

16

Gastric versus post-pyloric feeding: a systematic review  

PubMed Central

Background Our objective was to evaluate the impact of gastric versus post-pyloric feeding on the incidence of pneumonia, caloric intake, intensive care unit (ICU) length of stay (LOS), and mortality in critically ill and injured ICU patients. Method Data sources were Medline, Embase, Healthstar, citation review of relevant primary and review articles, personal files, and contact with expert informants. From 122 articles screened, nine were identified as prospective randomized controlled trials (including a total of 522 patients) that compared gastric with post-pyloric feeding, and were included for data extraction. Descriptive and outcomes data were extracted from the papers by the two reviewers independently. Main outcome measures were the incidence of nosocomial pneumonia, average caloric goal achieved, average daily caloric intake, time to the initiation of tube feeds, time to goal, ICU LOS, and mortality. The meta-analysis was performed using the random effects model. Results Only medical, neurosurgical and trauma patents were enrolled in the studies analyzed. There were no significant differences in the incidence of pneumonia, percentage of caloric goal achieved, mean total caloric intake, ICU LOS, or mortality between gastric and post-pyloric feeding groups. The time to initiation of enteral nutrition was significantly less in those patients randomized to gastric feeding. However, time to reach caloric goal did not differ between groups. Conclusion In this meta-analysis we were unable to demonstrate a clinical benefit from post-pyloric versus gastric tube feeding in a mixed group of critically ill patients, including medical, neurosurgical, and trauma ICU patients. The incidences of pneumonia, ICU LOS, and mortality were similar between groups. Because of the delay in achieving post-pyloric intubation, gastric feeding was initiated significantly sooner than was post-pyloric feeding. The present study, while providing the best current evidence regarding routes of enteral nutrition, is limited by the small total sample size. PMID:12793890

Marik, Paul E; Zaloga, Gary P

2003-01-01

17

Behavioral/Systems/Cognitive Lobster (Panulirus interruptus) Pyloric Muscles Express the  

E-print Network

Behavioral/Systems/Cognitive Lobster (Panulirus interruptus) Pyloric Muscles Express the Motor innervated by each motor neuron type of the rapid, rhythmic (cycle period, 1 sec) lobster pyloric network neural networks, although only one (the pyloric) innervates the muscles. Keywords:pyloricnetwork;lobster

Weaver, Adam Lee

18

Isolated Bilateral Congenital Iris Sphincter Agenesis  

PubMed Central

Purpose. We herein report a patient with bilateral congenital total iris sphincter agenesis with no other abnormality detected on systemic examination. Methods. A 24-year-old laborer presented to us for a routine checkup with complaint of photophobia and inability to work under sunlight. Examination revealed bilateral absence of sphincter and 6.5?mm pupil in both eyes in the undilated state. Results. Accommodation was poor in both eyes. Systemic examination was within normal limits. He was prescribed bifocal photochromic glasses for constant wear. Conclusions. Congenital sphincter agenesis can occur in an isolated form without systemic abnormalities which can be managed conservatively. PMID:22606462

Rao, Aparna

2011-01-01

19

Ethanol inhibits sphincter of oddi motility  

Microsoft Academic Search

Patients with alcohol-induced liver disease are at increased risk for pigment gallstones, which are known to be particularly\\u000a associated with biliary stasis. Although the effects of ethanol on the sphincter of Oddi are thought to contribute to alcoholic\\u000a pancreatitis, the precise effects of ethanol on the biliary component of the sphincter of Oddi are unclear. In the prairie\\u000a dog the

Sean Tierney; Zhiping Qian; Pamela A. Lipsett; Henry A. Pitt; Keith D. Lillemoe

1998-01-01

20

Simultaneous penile prosthesis and male sling/artificial urinary sphincter  

PubMed Central

Erectile dysfunction (ED) and stress urinary incontinence (SUI) from urethral sphincteric deficiency is not an uncommon problem. The commonest etiology is intervention for localized prostate cancer and/or radical cystoprostatectomy for muscle invasive bladder cancer. Despite advances in surgical technology with robotic assisted laparoscopic prostatectomy and nerve sparing techniques, the rates of ED and SUI remain relatively unchanged. They both impact greatly on quality of life domains and have been associated with poor performance outcomes. Both the artificial urinary sphincter and penile prosthesis are gold standard treatments with proven efficacy, satisfaction and durability for end-stage SUI and ED respectively. Simultaneous prosthesis implantation for concurrent conditions has been well described, mostly in small retrospective series. The uptake of combination surgery has been slow due in part to technical demands of the surgery and to an extent, a heightened anxiety over potential complications. This paper aims to discuss the technical aspect of concurrent surgery for both disease entity and the current published outcomes of the various surgical techniques with this approach. PMID:23202702

Lee, Dominic; Romero, Claudio; Alba, Frances; Westney, O Lenaine; Wang, Run

2013-01-01

21

Botulinum A toxin as a treatment of detrusor- sphincter dyssynergia in patients with spinal cord injury: MRI controlled transperineal injections  

PubMed Central

OBJECTIVES—To correlate clinical and urodynamic findings with MRI in patients with spinal cord injury and detrusor-sphincter dyssynergia who were consecutively treated with transperineal injections of botulinum-A toxin (BTX-A) under EMG control.?METHODS—Six patients with spinal cord injury and upper motor neuron bladder dysfunction associated with detrusor- sphincter dyssynergia were prospectively analysed. One hundred international units (IU) BTX-A (Botox® in 1 ml normal saline without preservative) diluted 1 to 1 with 1 ml gadopentetate were injected transperineally under EMG control. MRI was started immediately after needle withdrawal.?RESULTS—In all six patients gadopentetate was located in the external urethral sphincter on MRI. In no patient did traces of gadopentetate appear in the perineal musculature located in the vicinity of the external urethral sphincter. No patient developed resistance to BTX-A. All patients showed an (ongoing) improvement of their voiding function after BTX-A injections.?CONCLUSIONS—Transperineal injections of BTX-A under EMG control are efficient in the release or amelioration of lower urinary tract obstruction due to detrusor sphincter dyssynergia in patients with spinal cord injury. Despite well described methods, EMG of the external urethral sphincter is difficult and it is not possible to definitively exclude false recordings of the surrounding perineal musculature. By the use of MRI it was shown that both the EMG recordings and transperineal injection method are precise.?? PMID:9343126

Schurch, B.; Hodler, J.; Rodic, B.

1997-01-01

22

LIM homeodomain transcription factor Isl1 directs normal pyloric development by targeting Gata3  

PubMed Central

Background Abnormalities in pyloric development or in contractile function of the pylorus cause reflux of duodenal contents into the stomach and increase the risk of gastric metaplasia and cancer. Abnormalities of the pyloric region are also linked to congenital defects such as the relatively common neonatal hypertrophic pyloric stenosis, and primary duodenogastric reflux. Therefore, understanding pyloric development is of great clinical relevance. Here, we investigated the role of the LIM homeodomain transcription factor Isl1 in pyloric development. Results Examination of Isl1 expression in developing mouse stomach by immunohistochemistry, whole mount in situ hybridization and real-time quantitative PCR demonstrated that Isl1 is highly expressed in developing mouse stomach, principally in the smooth muscle layer of the pylorus. Isl1 expression was also examined by immunofluorescence in human hypertrophic pyloric stenosis where the majority of smooth muscle cells were found to express Isl1. Isl1 function in embryonic stomach development was investigated utilizing a tamoxifen-inducible Isl1 knockout mouse model. Isl1 deficiency led to nearly complete absence of the pyloric outer longitudinal muscle layer at embryonic day 18.5, which is consistent with Gata3 null mouse phenotype. Chromatin immunoprecipitation, luciferase assays, and electrophoretic mobility shift assays revealed that Isl1 ensures normal pyloric development by directly targeting Gata3. Conclusions This study demonstrates that the Isl1-Gata3 transcription regulatory axis is essential for normal pyloric development. These findings are highly clinically relevant and may help to better understand pathways leading to pyloric disease. PMID:24674670

2014-01-01

23

Pancreatoduodenectomy with or without pyloric preservation: a clinical outcomes comparison.  

PubMed

Pyloric preservation (PP) can frequently be performed at the time of pancreatoduodenectomy (PD), although some reports have linked it to inferior outcomes such as delayed gastric emptying (DGE). We reviewed records in a single-surgeon practice to assess outcomes after PD with or without PP. There were 133 PDs with 67 PPPDs and 66 PDs. Differences between PPPD and PD groups included cancer frequency, tumor size, OR time, blood loss, and transfusion rate. However, postoperative morbidity rate and grade, NG tube duration, NGT reinsertion rate, DGE, and length of stay were similar. There was no difference among patients with pancreatic cancer. No detrimental outcomes are associated with pyloric preservation during PD. Greater intraoperative ease and superior survival in the PPPD group are due to confounding, tumor-related variables in this nonrandomized comparison. Nevertheless, we intend to continue the use of PP with our technique in patients who meet the stated criteria. PMID:19197376

Dineen, Sean P; Roland, Christina L; Schwarz, Roderich E

2008-01-01

24

Pyloric trichobezoar in a Canadian lynx (Lynx canadensis).  

PubMed

An adult female Canadian lynx (Lynx canadensis) was presented with a 3-wk history of anorexia and lethargy. Initial examination and diagnostics did not provide a diagnosis. The lynx continued to demonstrate vague clinical signs, including anorexia and an abnormal gait. During follow-up immobilizations 2 wk later, a barium gastrointestinal study revealed a pyloric obstruction. Abdominal exploratory surgery was elected, and a gastrotomy and an enterotomy of the proximal duodenum were performed to remove the pyloric obstruction. The obstruction was determined to be a trichobezoar. Fleas, a likely cause of hair ingestion through grooming, were noted during surgical preparation. The lynx made a full recovery from surgery. Reoccurrence of the trichobezoar was prevented after surgery with the use of monthly flea control and three times a week hairball laxative. PMID:24450081

Kottwitz, Jack; Munsterman, Amelia S

2013-12-01

25

Obstetric events leading to anal sphincter damage  

Microsoft Academic Search

Objective: To identify the obstetric factors relating to anal sphincter injury at first vaginal delivery by prospective cohort study of primiparous women.Methods: We compared the results of a bowel function questionnaire and anal vector manometry before and 6 weeks after delivery in 184 primiparous women. Postpartum, pudendal nerve conduction latency was measured in all women, and anal endosonography was performed

Valerie Donnelly; Michelle Fynes; Deirdre Campbell; Howard Johnson; P. Ronan O’Connell; Colm O’Herlihy

1998-01-01

26

Clinical and Functional Anatomy of the Urethral Sphincter  

PubMed Central

Continence and micturition involve urethral closure. Especially, insufficient strength of the pelvic floor muscles including the urethral sphincter muscles causes urinary incontinence (UI). Thus, it is most important to understand the main mechanism causing UI and the relationship of UI with the urethral sphincter. Functionally and anatomically, the urethral sphincter is made up of the internal and the external sphincter. We highlight the basic and clinical anatomy of the internal and the external sphincter and their clinical meaning. Understanding these relationships may provide a novel view in identifying the main mechanism causing UI and surgical techniques for UI. PMID:23094214

Ahn, Hyo Kwang; Huh, Youngbuhm

2012-01-01

27

Follower Neurons in Lobster (Panulirus interruptus) Pyloric Network Regulate Pacemaker Period in Complementary Ways  

E-print Network

Follower Neurons in Lobster (Panulirus interruptus) Pyloric Network Regulate Pacemaker Period November 2002 Weaver, Adam L. and Scott L. Hooper. Follower neurons in lobster (Panulirus interruptus this technique to study cycle period control in the rhythmic pyloric network of the lobster, Panulirus

Hooper, Scott

28

Mechanisms Underlying Stabilization of Temporally Summated Muscle Contractions in the Lobster (Panulirus) Pyloric System  

E-print Network

Mechanisms Underlying Stabilization of Temporally Summated Muscle Contractions in the Lobster in the lobster (Panulirus) pyloric system. J Neurophysiol 85: 254­268, 2001. Mus- cles are the final effectors contraction in the well- investigated lobster pyloric system. We report here the mechanisms underlying

Hooper, Scott

29

Relating Network Synaptic Connectivity and Network Activity in the Lobster (Panulirus interruptus) Pyloric Network  

E-print Network

Relating Network Synaptic Connectivity and Network Activity in the Lobster (Panulirus interruptus in the lobster (Panulirus interrup- tus) pyloric network. J Neurophysiol 90: 2378­2386, 2003. First published June 11, 2003; 10.1152/jn.00705.2002. The lobster pyloric network has a densely interconnected synaptic

Hooper, Scott

30

Infantile hypertrophic pyloric stenosis in Belfast, 1957-1969.  

PubMed Central

Infants with hypertrophic pyloric stenosis born in Belfast during the 13 years 1957-1969 have been reviewed. Their distribution shows a bias towards higher social classes, breast feeding, and primogeniture. Obstetric factors and parental ages seem to be of no importance. More affected infants were born during winter months than would be expected. The overall incidence of infantile pyloric stenosis in this community has fallen during the period under review. Clinically, the patients started vomiting at a mean age of 22 days and it is recommended that the condition should not be called 'congenital'. The size of the tumour is mainly determined by the size of the patient, rather than by his age or duration of symptoms. Attention is drawn to the occurrence of haematemesis in 17-5% and melaena in 2-9% of infants. Jaundice occurred in 1-8% of patients in this series, and is attributed to the adverse effect of starvation on hepatic glucuronyl transferase activity. Other conditions noted in these patients included inguinal hernia, partial thoracic stomach, and phenylketonuria. Subsequent growth and development were in the anticipated range. PMID:1170811

Dodge, J A

1975-01-01

31

Pseudodyssynergia (Contraction of the External Sphincter During Voiding) Misdiagnosed as Chronic Nonbacterial Prostatitis and the Role of Biofeedback as a Therapeutic Option  

Microsoft Academic Search

PurposeChronic lower urinary tract symptoms in young men are often attributed to misdiagnosed chronic nonbacterial prostatitis. We analyzed contraction of the external urinary sphincter during voiding (pseudodyssynergia) as an etiology of voiding dysfunction in men with misdiagnosed chronic prostatitis.

Steven A. Kaplan; Richard P. Santarosa; Patricia Meade D'Alisera; Brenda J. Fay; Edward F. Ikeguchi; James Hendricks; Lonnie Klein; Alexis E. Te

1997-01-01

32

Sphincter repair for fecal incontinence after obstetrical or iatrogenic injury  

Microsoft Academic Search

Forty patients with fecal incontinence underwent sphincter repair between 1975 and 1984. Divided sphincter musculature resulted\\u000a from obstetrical injury in 23 and previous anorectal surgery in 17. Eighteen had undergone a previous attempt at repair. Fifteen\\u000a patients experienced seepage of stool and 25 had gross incontinence. In nine patients, reconstruction of the external sphincter\\u000a was by overlap of the muscle

Michael E. Pezim; Robert J. Spencer; C. Robert Stanhope; Robert W. Beart; Roger L. Ready; Duane M. Ilstrup

1987-01-01

33

Sphincter tears in primiparous women: is age a factor?  

Microsoft Academic Search

Anal sphincter tears during vaginal delivery may result in serious sequelae. We examined whether younger primiparous patients\\u000a were at increased risk for sphincter tears during vaginal delivery. Data from an obstetric automated record were analyzed.\\u000a Primiparous women delivering term infants (n?=?5,937) were included to test for an association between age and sphincter tear rates. Three age groups were considered:\\u000a young

C. Bryce Bowling; Thomas L. Wheeler II; Kimberly A. Gerten; Victoria R. Chapman; Kathryn L. Burgio; Holly E. Richter

2009-01-01

34

The functional sphincter of Oddi disorder.  

PubMed

The sphincter of Oddi disorder (SOD) has been a controversial subject for many years, about which a lot has been written. However, new findings mainly using Endoscopic Retrograde Cholangiopancreatography (ERCP) and sphincter of Oddi manometry (SOM) demonstrate the fact of this diagnostic. SOD is just a part of a larger pathology, the tfunctional gastrointestinal disorders, which have been reconsidered as an important part of gastrointestinal diseases. For a better understanding, the American Gastroenterology Association Institute created a new classification of The Functional Gastrointestinal Disorders in 2006, Rome III Classification, in which the SOD is grouped in the functional biliary disorders (category E). The term SOD is used to define manometric abnormalities in patients who have signs and symptoms consistent with a biliary or pancreatic ductal origin. Based on the pathogenic mechanism and manometry findings, the SOD is separated into two groups: a group characterized by a stenotic pattern (anatomical abnormality) and a second group with a dyskinetic pattern functional abnormality). The purpose of this article is to construct a short presentation of the main aspects regarding tfunctional SOD (E2 and E3 after Rome III Classificatio). PMID:20108458

Pop, Corina; Purc?reanu, Adina; Purc?rea, Monica; Andronescu, Dan

2008-01-01

35

Decelerating burst and complex repetitive discharges in the striated muscle of the urethral sphincter, associated with urinary retention in women.  

PubMed Central

A type of electromyographic activity, formerly referred to as "pseudomyotonia", can be recorded from the striated muscle of the urethral sphincter using a concentric needle electrode. There are two components to this activity, complex repetitive discharges and decelerating bursts. The latter usually dominate recordings and sound very like myotonic discharges. Analysis of these discharges indicates that they are a form of "bizarre repetitive discharge", and as such, result from ephaptic spread of excitation between muscle fibres rather than from excitation arising in the terminal branches of the motor axon. Profuse activity of this type has been found in 15 women with symptoms of urethral dysfunction, including 11 with urinary retention. It is suggested that this activity is associated with a failure of urethral sphincter relaxation. Images PMID:4056803

Fowler, C J; Kirby, R S; Harrison, M J

1985-01-01

36

Sphincter-saving procedures for distal carcinoma of the rectum.  

PubMed Central

Methods of sphincter preservation were developed more than a century ago. Combining these techniques with adequate anterior resection has permitted the resurrection of sphincter-saving procedures that are currently being applied in the therapy of cancer at every level of the rectum. Although Miles' abdominoperineal resection still remains the "gold standard" for the treatment of low rectal neoplasms, restorative resection may now be possible with equivalent oncologic disease control and survival. Further, current trends also suggest that the abdominoperineal resection is being used less frequently in the treatment of most rectal cancers and is being replaced with sphincter-preserving techniques that afford excellent functional results. In this review, the pertinent anorectal anatomy, current issues, and sphincter-saving surgical techniques presently available for the treatment of distal cancers of the rectum are presented. PMID:2642688

Yeatman, T J; Bland, K I

1989-01-01

37

Quantification of Cardiac Sac Network Effects on a Movement-Related Parameter of Pyloric Network Output in the Lobster  

E-print Network

Output in the Lobster JEFF B. THUMA AND SCOTT L. HOOPER Neuroscience Program, Department of Biological on a movement-related parameter of pyloric network output in the lobster. J Neurophysiol 89: 745­753, 2003; 10 of cardiac sac activity on the OSF of all pyloric neurons in the lobster, Panulirus interruptus

Hooper, Scott

38

Question of an infectious etiology or contribution to the pathogenesis of infantile hypertrophic pyloric stenosis.  

PubMed

Infantile hypertrophic pyloric stenosis is a concerning cause of nonbilious vomiting in the neonatal population. Although a number of etiological theories exist, its exact cause remains nebulous. The question of an infectious etiology (or contribution) has been previously examined in case reports and case series, with recent support through suggestions of seasonality and familial aggregation with unclear inheritance patterns. The present review discusses the published literature regarding infectious etiologies of infantile hypertrophic pyloric stenosis. Furthermore, it attempts to demonstrate that newer research regarding an NOS1 genetic etiology does not exclude, but rather can be consistent with, an infectious etiology. PMID:24345839

Modarressi, Taher

2014-05-01

39

A catheter-based acoustic interrogation device for monitoring motility dynamics of the lower esophageal sphincter.  

PubMed

This paper presents novel minimally-invasive, catheter-based acoustic interrogation device for monitoring motility dynamics of the lower esophageal sphincter (LES). A micro-oscillator actively emitting sound wave at 16 kHz is located at one side of the LES, and a miniature microphone is located at the other side of the sphincter to capture the sound generated from the oscillator. Thus, the dynamics of the opening and closing of the LES can be quantitatively assessed. In this paper, experiments are conducted utilizing an LES motility dynamics simulator. The sound strength is captured by the microphone and is correlated to the level of LES opening and closing controlled by the simulator. Measurements from the simulator model show statistically significant (p < 0.05) Pearson correlation coefficients (0.905 on the average in quiet environment and 0.736 on the average in noisy environment, D.O.F. = 9). Measuring the level of LES opening and closing has the potential to become a valuable diagnostic technique for understanding LES dysfunction and the disorders associated with it. PMID:25120160

Lu, Qian; Yadid-Pecht, Orly; Sadowski, Daniel C; Mintchev, Martin P

2014-01-01

40

A Catheter-Based Acoustic Interrogation Device for Monitoring Motility Dynamics of the Lower Esophageal Sphincter  

PubMed Central

This paper presents novel minimally-invasive, catheter-based acoustic interrogation device for monitoring motility dynamics of the lower esophageal sphincter (LES). A micro-oscillator actively emitting sound wave at 16 kHz is located at one side of the LES, and a miniature microphone is located at the other side of the sphincter to capture the sound generated from the oscillator. Thus, the dynamics of the opening and closing of the LES can be quantitatively assessed. In this paper, experiments are conducted utilizing an LES motility dynamics simulator. The sound strength is captured by the microphone and is correlated to the level of LES opening and closing controlled by the simulator. Measurements from the simulator model show statistically significant (p < 0.05) Pearson correlation coefficients (0.905 on the average in quiet environment and 0.736 on the average in noisy environment, D.O.F. = 9). Measuring the level of LES opening and closing has the potential to become a valuable diagnostic technique for understanding LES dysfunction and the disorders associated with it. PMID:25120160

Lu, Qian; Yadid-Pecht, Orly; Sadowski, Daniel C.; Mintchev, Martin P.

2014-01-01

41

[Duspatalin in functional disorders of the Oddi's sphincter in patients subjected cholecystectomy].  

PubMed

There was an examination of 20 patients who had cholecystectomy and have dysfunctional disorders of the Oddi's sphincter. All of the patients underwent the monotherapy with Mebeverine Retard in the dosage of 200 mg twice a day. The treatment efficiency was evaluated by the dynamics of clinical symptoms, results of the study of biochemical blood indices, data of the ultrasonic examination, and intragastric pH measurement. A positive dynamics was observed against the background of the preparation administration, and it became apparent from the disappearance or reduction of pains strength, dyspeptic manifestations, normalization or improvement of biochemical blood indices, and reduction of the common bile duct lumen width according to the ultrasonic examination data. PMID:12503268

Il'chenko, A A; Bystrovskaia, E V

2002-01-01

42

Temperature Sensitivity of the Pyloric Neuromuscular System and Its Modulation by Dopamine  

E-print Network

Temperature Sensitivity of the Pyloric Neuromuscular System and Its Modulation by Dopamine Jeffrey the effects of temperature on the p1 neuromuscular system of the stomatogastric system of the lobster as temperature increased, sufficiently that stomach movements would very unlikely be maintained at warm

Hooper, Scott

43

Effects of pyloric local CGRP and NO on bile reflux in rat stomach with stress ulcer  

Microsoft Academic Search

AIM: To investigate the effects of pyloric local CGRP and NO on bile reflux in rat stomach with stress ulcer. METHODS: Rats stress ulcer model was established by cold water soaking. Sixty-five rats were divided into three groups: normal control group, the stress group and the antagonist group. The gastric ulcer index, pH and bile acid of gastric juice were

Min Chen; He-Sheng Luo; Qiao-Yun Tong; Ji-Hong Chen; Xian-Zhen Li

44

Vagal control of lower oesophageal sphincter motility in the cat  

PubMed Central

1. The effects of vagal efferent fibre stimulation on the smooth muscle of the lower oesophageal sphincter have been studied on the anaesthetized animal and on the isolated and perfused organ. 2. In both muscle layers (longitudinal and circular) vagal stimulation elicits two types of electromyographic (e.m.g.) potentials: (a) excitatory junction potentials (e.j.p.s) where there is a depolarization of the smooth muscle fibres. E.j.p.s can give rise to spike potentials inducing a contraction of the sphincter; (b) inhibitory junction potentials (i.j.p.s) where there is hyperpolarization of the smooth muscle fibres, often followed by a transient depolarization which may initiate spikes (post-inhibitory rebound). 3. Pure i.j.p.s are observed after atropine treatment which suppresses e.j.p.s. Under these conditions, a long lasting vagal stimulation induces a long duration hyperpolarization concomitant with an opening of the lower oesophageal sphincter followed after the cessation of stimulation by a powerful rebound leading to a strong contraction which closes the sphincter. 4. Several arguments, pharmacological (action of acetylcholine (ACh), atropine and hexamethonium) and physiological (threshold and latency of responses) lead to the following conclusions. Preganglionic vagal fibres are cholinergic and they activate (a) intramural excitatory cholinergic neurones; (b) intramural non-adrenergic inhibitory neurones (purinergic neurones). Preganglionic fibres leading to inhibition have a higher threshold than those leading to excitation. Both excitatory and inhibitory pathways are interconnected inside the intramural network. In particular, activation of intramural inhibitory neurones, by relaxing the oesophagus orally to the lower oesophageal sphincter, inhibits intramural excitatory neurones and subsequently blocks vagal excitatory responses. 5. Two functions may be attributed to the vagal extrinsic innervation: (a) closure of the lower oesophageal sphincter by maintaining the basal tone of the sphincter; this would imply that at rest the inhibitory control is supplanted by the excitatory one; (b) sphincter opening during swallowing by suppressing the excitatory stimulus and reinforcing the inhibitory one (it may be recalled that after bilateral vagotomy, swallowing is no longer followed by a relaxation of the sphincter). PMID:604452

Gonella, J.; Niel, J. P.; Roman, C.

1977-01-01

45

Quantitative anal sphincter EMG in multisystem atrophy and 100 controls  

PubMed Central

OBJECTIVE—To evaluate data of quantitative anal sphincter EMG in normal controls and to compare them with patients with multiple system atrophy (MSA).?METHODS—Quantitative anal sphincter EMG were performed on 100 normal controls and 11 patients with MSA to characterise EMG data in these two groups.?RESULTS—In the normal controls, there was a trend for increased motor unit potential (MUP) amplitude, duration, area, and polyphasicity with advancing age. Patients with MSA exhibited similar MUP size and fibre density. Significant differences were found only in parameters of the recruitment pattern, which were reduced in MSA, with a diminution in the number of active MUPs during rest.?CONCLUSIONS—These results may reflect either decreased number of motor cells in Onuf's nucleus without significant consequential reinnervation, or upper motor neuron involvement affecting the anal sphincter in MSA. They further underline the importance of comparative data for age matched controls.?? PMID:11606668

Gilad, R; Giladi, N; Korczyn, A; Gurevich, T; Sadeh, M

2001-01-01

46

Ultrasound imaging of the anal sphincter complex: a review.  

PubMed

Endoanal ultrasound is now regarded as the gold standard for evaluating anal sphincter pathology in the investigation of anal incontinence. The advent of three-dimensional ultrasound has further improved our understanding of the two-dimensional technique. Endoanal ultrasound requires specialised equipment and its relative invasiveness has prompted clinicians to explore alternative imaging techniques. Transvaginal and transperineal ultrasound have been recently evaluated as alternative imaging modalities. However, the need for technique standardisation, validation and reporting is of paramount importance. We conducted a MEDLINE search (1950 to February 2010) and critically reviewed studies using the three imaging techniques in evaluating anal sphincter integrity. PMID:22374273

Abdool, Z; Sultan, A H; Thakar, R

2012-07-01

47

Ultrasound imaging of the anal sphincter complex: a review  

PubMed Central

Endoanal ultrasound is now regarded as the gold standard for evaluating anal sphincter pathology in the investigation of anal incontinence. The advent of three-dimensional ultrasound has further improved our understanding of the two-dimensional technique. Endoanal ultrasound requires specialised equipment and its relative invasiveness has prompted clinicians to explore alternative imaging techniques. Transvaginal and transperineal ultrasound have been recently evaluated as alternative imaging modalities. However, the need for technique standardisation, validation and reporting is of paramount importance. We conducted a MEDLINE search (1950 to February 2010) and critically reviewed studies using the three imaging techniques in evaluating anal sphincter integrity. PMID:22374273

Abdool, Z; Sultan, A H; Thakar, R

2012-01-01

48

Prenatal detection of epidermolysis bullosa letalis with pyloric atresia in a fetus by abnormal ultrasound and elevated alpha-fetoprotein.  

PubMed

We report on the prenatal diagnosis of epidermolysis bullosa letalis with pyloric atresia in a pregnancy not known to be at risk for this condition. Elevated maternal serum alpha-fetoprotein levels led to ultrasonography which demonstrated gastric dilatation, consistent with pyloric atresia, and echogenic particles in the amniotic fluid, the "snowflake sign," previously described in two pregnancies of fetuses with disorders of skin sloughing. Amniotic fluid alpha-fetoprotein was markedly elevated and the acetylcholinesterase was positive. The diagnosis of epidermolysis bullosa letalis with pyloric atresia was confirmed after delivery by electron microscopy of fetal skin which showed typical changes of hypoplastic absent hemidesmosomes and separation along the dermal-epidermal junction. None of these abnormal prenatal findings are consistently present in pregnancies with epidermolysis bullosa with pyloric atresia. Thus, although useful when abnormal, when the test results are normal, the need for confirmatory fetoscopy and fetal skin biopsy remains. PMID:7510931

Dolan, C R; Smith, L T; Sybert, V P

1993-09-01

49

Neuroanatomy of the External Urethral Sphincter: Implications for Urinary Continence Preservation During Radical Prostate Surgery  

Microsoft Academic Search

Post-prostatectomy urinary incontinence probably is multifactorial and sphincteric nerve injury could be a contributing cause. Controversy still exists regarding the innervation of the external sphincter, and currently pudendal nerve injury is not believed to be an etiological factor in post-prostatectomy urinary incontinence. To understand better the sphincter and its innervation, we undertook an anatomical and histological study of 18 adult

Perinchery Narayan; Badrinath Konety; Khalid Aslam; Sherif Aboseif; Walter Blumenfeld; Emil. Tanagho

1995-01-01

50

The evolution of artificial sphincter cuff in growing animals.  

PubMed

An animal model was developed to simulate the effect of implantation of artificial sphincter cuff on the urethra in children. The study was conducted on 28 pigs, 15 castrated males, four uncastrated males and nine females, divided into four groups: control unoperated, and three operated groups. Group I contained young piglets (castrated males, uncastrated males and females), group II contained adult animals and group III contained sham operated animals. An AS 800 belt occlusion cuff was implanted in the deflated state distal to the bladder neck around the urethra in the young and adult groups, while no sphincter was implanted in the sham group. Neither primary nor secondary activation was done. The pigs were followed for a period of six to eight weeks and then sacrificed. The morphological and histological observations on the effects of the artificial sphincter cuff on the underlying urethral tissue showed significant transmural atrophy of the urethral and prostatic segment underlying the cuff in the young growing castrated and uncastrated male group with mild changes in the young female group. Bladder rupture occurred in three uncastrated males. There were no changes encountered in the adult or sham operated groups. Variable degrees of upper tract changes and renal deterioration were seen in the young group. These changes occurred mainly in the male piglets while a lesser degree occurred in the female piglets. No changes were demonstrated in the adult and sham groups. This study suggests the possibility of similar changes occurring in young male children who have undergone artificial sphincter implantation. PMID:3411693

Mokhless, I; Hassouna, M M; Kiruluta, G H; Seemeyer, T A; Homsy, Y L; Coolsaet, B L; Elhilali, M M

1988-09-01

51

Displacement of the abomasum to the left side and pyloric obstruction in a goat  

Microsoft Academic Search

Summary A 4-year-old female native goat with the history of inappetence and no defecation was referred to the Department of Clinical Sciences, School of Veterinary Medicine of Shiraz, Shiraz, southern Iran. During exploratory laparotomy, pyloric obstruction and displacement of the abomasum to the left side was observed. Obstruction of pylorus was due to a ball-shaped phytobezoar. The goat was followed

Meimandi Parizi; Rowshan Ghasrodashti; A. Meimandi

52

Radiologic Findings in Cutis Laxa Syndrome and Unusual Association with Hypertrophic Pyloric Stenosis  

PubMed Central

Cutis laxa (CL) is a rare congenital and acquired disorder characterized by loose and redundant skin with reduced elasticity. Three types of congenital cutis laxa have been recognized. Other findings are pulmonary emphysema, bronchiectasia, hernia and diverticulosis. We describe a female neonate involved by cutis laxa syndrome and a positive family history. We focus on the radiologic findings of this case such as multiple bladder diverticulosis, GI diverticulosis and very rare accompanying hypertrophic pyloric stenosis (HPS). PMID:24046787

Alehossein, Mehdi; Pourgholami, Masoud; Kamrani, Kamyar; Soltani, Mohammad; Yazdi, Afshin; Salamati, Payman

2013-01-01

53

Safety and efficacy of a partially covered self-expandable metal stent in benign pyloric obstruction  

PubMed Central

AIM: To evaluate the safety and efficacy of partially covered self-expandable metallic stents (SEMSs) in benign pyloric obstruction. METHODS: We retrospectively analyzed data from 10 consecutive patients with peptic ulcer-related pyloric obstructive symptoms (gastric outlet obstruction scoring system (GOOSS) score of 1) between March 2012 and September 2013. The patients were referred to and managed by partially covered SEMS insertion in our tertiary academic center. We assessed the technical success, symptom improvement, and adverse events after stenting. RESULTS: Early symptoms were improved just 3 d after SEMS placement in all 10 patients. The GOOSS score of all patients improved from 1 to 3. There were no serious immediate adverse events. The overall rate of being symptom free was 90% at a median of 11 mo of follow-up (range: 4-43 mo). Five patients were managed by a rescue SEMS because of failure of previous endoscopic balloon dilatation. Among them, four patients had sustained symptom improvement after the SEMS procedure. During the follow-up period, migration of the SEMS was observed in two patients (20.0%), both of whom had previous endoscopic balloon dilatation before SEMS insertion. CONCLUSION: Despite the small number in this study, partially covered SEMSs showed a favorable and safe outcome in the treatment of naïve benign pyloric obstruction and in salvage treatment after balloon dilatation failure. PMID:25469043

Heo, Jun; Jung, Min Kyu

2014-01-01

54

Gastrojejunostomy for pyloric stenosis after acute gastric dilatation due to overeating.  

PubMed

A 34-year-old woman presented at our hospital with abdominal distention due to overeating. Acute gastric dilatation was diagnosed. The patient was hospitalized, and nasogastric decompression was initiated. On hospitalization day 3, she developed shock, and her respiratory state deteriorated, requiring intubation and mechanical ventilation. Nasogastric decompression contributed to the improvement in her clinical condition. She was discharged 3 mo after admission. During outpatient follow-up, her dietary intake decreased, and her body weight gradually decreased by 14 kg. An upper gastrointestinal series and endoscopy revealed pyloric stenosis; therefore, we performed gastrojejunostomy 18 mo after her initial admission. The patient was discharged from the hospital with no postoperative complications. Gastric necrosis and perforation due to overeating-induced gastric dilatation are life-threatening conditions. Surgical intervention may be required if delayed pyloric stenosis occurs after conservative treatment. We report a case of pyloric stenosis due to overeating-induced gastric dilatation treated by gastrojejunostomy 18 mo after the initial presentation. PMID:25663789

Kimura, Akiharu; Masuda, Norihiro; Haga, Norihiro; Ito, Tomokazu; Otsuka, Kichirou; Takita, Jyunko; Satomura, Hitoshi; Kumakura, Yuji; Kato, Hiroyuki; Kuwano, Hiroyuki

2015-02-01

55

Plectin Deficiency Leads to Both Muscular Dystrophy and Pyloric Atresia in Epidermolysis Bullosa Simplex  

PubMed Central

Plectin is a cytoskeletal linker protein which has a long central rod and N- and C-terminal globular domains. Mutations in the gene encoding plectin (PLEC) cause two distinct autosomal recessive subtypes of epidermolysis bullosa: EB simplex (EBS) with muscular dystrophy (EBS-MD), and EBS with pyloric atresia (EBS-PA). Previous studies have demonstrated that loss of full-length plectin with residual expression of the rodless isoform leads to EBS-MD, whereas complete loss or marked attenuation of expression of full-length and rodless plectin underlies the more severe EBS-PA phenotype. However, muscular dystrophy has never been identified in EBS-PA, not even in the severe form of the disease. Here, we report the first case of EBS associated with both pyloric atresia and muscular dystrophy. Both of the premature termination codon-causing mutations of the proband are located within exon 32, the last exon of PLEC. Immunofluorescence and immunoblot analysis of skin samples and cultured fibroblasts from the proband revealed truncated plectin protein expression in low amounts. This study demonstrates that plectin deficiency can indeed lead to both muscular dystrophy and pyloric atresia in an individual EBS patient. © 2010 Wiley-Liss, Inc. PMID:20665883

Natsuga, Ken; Nishie, Wataru; Shinkuma, Satoru; Arita, Ken; Nakamura, Hideki; Ohyama, Makiko; Osaka, Hitoshi; Kambara, Takeshi; Hirako, Yoshiaki; Shimizu, Hiroshi

2010-01-01

56

Gastrojejunostomy for pyloric stenosis after acute gastric dilatation due to overeating  

PubMed Central

A 34-year-old woman presented at our hospital with abdominal distention due to overeating. Acute gastric dilatation was diagnosed. The patient was hospitalized, and nasogastric decompression was initiated. On hospitalization day 3, she developed shock, and her respiratory state deteriorated, requiring intubation and mechanical ventilation. Nasogastric decompression contributed to the improvement in her clinical condition. She was discharged 3 mo after admission. During outpatient follow-up, her dietary intake decreased, and her body weight gradually decreased by 14 kg. An upper gastrointestinal series and endoscopy revealed pyloric stenosis; therefore, we performed gastrojejunostomy 18 mo after her initial admission. The patient was discharged from the hospital with no postoperative complications. Gastric necrosis and perforation due to overeating-induced gastric dilatation are life-threatening conditions. Surgical intervention may be required if delayed pyloric stenosis occurs after conservative treatment. We report a case of pyloric stenosis due to overeating-induced gastric dilatation treated by gastrojejunostomy 18 mo after the initial presentation. PMID:25663789

Kimura, Akiharu; Masuda, Norihiro; Haga, Norihiro; Ito, Tomokazu; Otsuka, Kichirou; Takita, Jyunko; Satomura, Hitoshi; Kumakura, Yuji; Kato, Hiroyuki; Kuwano, Hiroyuki

2015-01-01

57

Ultrastructural observations of the myenteric plexus of the pylorus in infantile hypertrophic pyloric stenosis.  

PubMed Central

Myenteric plexuses and smooth muscle of the pylorus obtained by biopsy at pyloro myotomy in 5 infants with hypertrophic pyloric stenosis were studied by electron microscopy. Animal controls consisted of pyloruses from 2 infant and 2 adult rabbits and 2 adult rats. The principal findings in the plexuses of the patients were moderate numbers of variably sized, swollen degenerating axons that contained dense bodies, lamellated figures, vacuoles, granular or fibrillar material, and swollen mitochondria. The significance of this alteration in the etiology and pathogenesis of this disorder is not clear. Neurons in the plexuses showed no definite abnormalities. Although these findings do not confirm previous light microscopic observation of neuronal changes in the pyloric myenteric plexuses, they do not exclude a neurogenic mechanism for this disorder. The presence of small immature neurons and large mature neurons suggests that neuronal maturation and development in infantile hypertrophic pyloric stenosis are not impaired as previously reported. No ultrastructural changes were found in interstitial cells of the myenteric plexuses. Except for hypertrophy of the circular smooth muscle layers, no specific alterations were found in muscle fibers of the pylorus. Images Figure 5 Figure 6 Figure 7 Figure 8 Figure 1 Figure 9 Figure 2 Figure 3 Figure 4 PMID:879274

Challa, V. R.; Jona, J. Z.; Markesbery, W. R.

1977-01-01

58

EMERGING ROLE OF BOTULINUM TOXIN IN THE MANAGEMENT OF VOIDING DYSFUNCTION  

Microsoft Academic Search

Purpose:In recent years there has been tremendous excitement over the use of botulinum neurotoxin (BTX) to treat various urethral and bladder dysfunctions. BTX is the most potent, naturally occurring toxin known to mankind. Why, then, would a urologist want to use this agent to poison the bladder or urethral sphincter?

CHRISTOPHER P. SMITH; MICHAEL B. CHANCELLOR

2004-01-01

59

[Pathophysiologic role of the internal anal sphincter in chronic anal fissure].  

PubMed

Internal anal sphincter manometric and myoelectrical investigations were performed under basal conditions and in response to rectal distension in 17 patients with chronic anal fissures and 15 controls. Measurement of sphincter pressures were carried out by pull-through technique, using water perfused open-tip-catheters. Electrical signals were obtained employing concentric needle electrodes inserted into the internal anal sphincter. No statistically different resting pressures were noted between patients with fissures and controls. Just so no significant difference were found in frequency and amplitude of slow potentials generated by the internal and sphincter. Neither amplitude or frequency correlate with anal sphincter pressures. In both groups, transient rectal distension produced relaxation of the internal sphincter and were associated with inhibition or irregularity of electric activity. Distribution and amplitude of internal overshoot contraction showed no difference in both groups. It can be concluded that internal sphincter spasm can not be considered as the sole cause for persistence of fissures. PMID:4082687

Braun, J; Raguse, T

1985-10-01

60

[Significance of biliary dysfunction in the pathogenesis of gallstone disease].  

PubMed

The paper shows the role of biliary dysfunction in the formation of biliary sludge. Found that among all motor dysfunction themost common is reduction of contractile function of the gallbladder (in 63.3% of cases), which is combined with 73.2% Oddi's sphincter hypertonus. T The combination of ursodeoxycholic acid (UDCA) with mebeverine has a better effect than monotherapy with UDCA, as increases the frequency of relief of biliary dyspepsia symptoms, normalizes the biliary tract functional status and 95% of cases leads to the elimination of biliary sludge. PMID:22364003

Il'chenko, I A; Deliukina, O V

2011-01-01

61

[A method of creating the sphincter apparatus of the rectum].  

PubMed

The data on surgical anatomy of the musculus gracilis, which is used for sphincteroplasty, is presented. In the experiment on 25 dogs with modelled incompetence of the anal sphincter, a technique for cutting the non-free flaps out of the musculus gracilis and creation of obturator apparatus of the rectum has been developed. The advantages of a developed method over the existing ones, efficacy and possibility for its use in the clinic are shown. PMID:1564856

Tat'ianchenko, V K

1992-01-01

62

Purification and characterization of trypsin from the pyloric ceca of orange-spotted grouper, Epinephelus coioides.  

PubMed

Trypsin from the pyloric ceca of orange-spotted grouper, Epinephelus coioides, was purified by fractionation with ammonium sulfate, ionic exchange, and affinity chromatography. The protein was purified 161.85-fold with a yield of 4%. Purified trypsin had an apparent molecular weight of 24 kDa according to an SDS-PAGE analysis. Optimal profiles of temperature and pH of the enzyme were 50°C and 8-10, respectively, using N?-benzoyl-L: -arginine ethyl ester as the substrate. The results of thermal and pH stability assays showed that the enzyme was stable at temperatures of up to 50°C and in the pH range of 6-8. Trypsin activity decreased with an increasing NaCl concentration (0-0.6 M). The activity of purified trypsin was effectively inhibited by a soybean trypsin inhibitor and N-p-tosyl-L: -lysine chloromethyl ketone, and was slightly inhibited by iodoacetic acid, ethylenediaminetetraacetic acid, 1-(L: -trans-epoxysuccinyl-leucylamino)-4-guanidinobutane, and pepstatin A. Protein identification of the purified protease showed that the sequences of two peptides, LGEHNI and NLDNDIML, were highly homologous to other fish trypsins. The measurement of trypsin activity in different tissues showed that the highest activity was detected in pyloric ceca, followed by anterior intestine, middle intestine, hind intestine and spleen, but very low activities were found in other tissues. An inverse relationship between the trypsin activity in four tissues of pyloric ceca, anterior intestine, middle intestine and hind intestine and fish body weight as a result of increased pepsin in stomach indicated grouper growth status was increased. PMID:22068456

Liu, Chun-Hung; Shiu, Ya-Li; Hsu, Jue-Liang

2012-06-01

63

Antral web associated with distal antral hypertrophy and prepyloric stenosis mimicking hypertrophic pyloric stenosis  

PubMed Central

A 3-year-old boy presented with postprandial vomiting and epigastric pain for 3 wk. Barium meal study suggested hypertrophic pyloric stenosis. Ultrasound of the stomach after water loading revealed an echogenic antral web with an eccentric aperture and distal antral hypertrophy. Subsequent endoscopy confirmed the ultrasound findings. Web resection and antropyloroplasty resulted in excellent recovery. To our knowledge, the barium meal and ultrasound findings of an antral web-associated distal antral hypertrophy and prepyloric stenosis has not previously been described. PMID:15641157

Tiao, Mao-Ming; Ko, Sheung-Fat; Hsieh, Chie-Song; Ng, Shu-Hang; Liang, Chi-Di; Sheen-Chen, Shy Ming; Chuang, Jiin-Haur; Huang, Hsuan-Ying

2005-01-01

64

Response of the lower esophageal sphincter to gastric distention by carbonated beverages  

Microsoft Academic Search

Gastroesophageal reflux disease often occurs in patients with normal resting pressure and length of the lower esophageal sphincter.\\u000a Such patients often have postprandial reflux. The mechanism of postprandial reflux remains controversial. To further clarify\\u000a this, we studied the effect of carbonated beverages on the resting parameters of the lower esophageal sphincter. Nine asymptomatic\\u000a healthy volunteers underwent lower esophageal sphincter manometry

Nahid Hamoui; Reginald V. Lord; Jeffrey A. Hagen; Joerg Theisen; Tom R. DeMeester; Peter F. Crookes

2006-01-01

65

Characterisation of relaxation of the lower oesophageal sphincter in healthy premature infants.  

PubMed Central

BACKGROUND: Gastro-oesophageal reflux disease causes significant morbidity in premature infants, but the role of dysfunction of the lower oesophageal sphincter (LOS) in this condition is unclear. METHODS: Oesophageal manometry was performed after gavage feeding in 13 healthy preterm neonates (postmenstrual age > or = 33 weeks) with a perfused sleeve with side hole assembly. Swallow related (both single and multiple) and transient LOS relaxations (TLOSRs) were identified and the characteristics of these events defined. Reflux was identified with manometric criteria (common cavity episodes). RESULTS: Five hundred and eleven relaxation of the LOS were observed, 55% related to single swallows, 23% related to multiple swallows, and 22% TLOSRs. The time to maximal LOS relaxation was longer for TLOSRs than for single or multiple swallows (mean (SEM) 5.0 (0.3) s v 3.0 (0.1) s and 3.3 (0.1) s, p < 0.0001 and p < 0.005). The durations of multiple swallows and TLOSRs were longer than single swallows (12.2 (0.5) s and 11.2 (0.4) s v 5.3 (0.2) s, p < 0.0001). Most of the oesophageal body common cavity episodes (94%) occurred during TLOSRs. CONCLUSIONS: In healthy preterm infants (postmenstrual age > or = 33 weeks) the motor events associated with LOS relaxation were similar to those seen in healthy adults. TLOSRs may be an important mechanism of reflux in premature infants. PMID:9135527

Omari, T I; Miki, K; Davidson, G; Fraser, R; Haslam, R; Goldsworthy, W; Bakewell, M; Dent, J

1997-01-01

66

Effects of the Temporary Placement of a Self-Expandable Metallic Stent in Benign Pyloric Stenosis  

PubMed Central

Background/Aims The use of self-expandable metallic stents (SEMS) is an established palliative treatment for malignant stenosis in the gastrointestinal tract; therefore, its application to benign stenosis is expected to be beneficial because of the more gradual and sustained dilatation in the stenotic portion. We aimed in this prospective observational study to evaluate the efficacy and safety of temporary SEMS placement in benign pyloric stenosis. Methods Twenty-two patients with benign stenosis of the prepylorus, pylorus, and duodenal bulb were enrolled and underwent SEMS placement. We assessed symptom improvement, defined as an increase of at least 1 degree in the gastric-outlet-obstruction scoring system after stent insertion. Results No major complications were observed during the procedures. After stent placement, early symptom improvement was achieved in 18 of 22 patients (81.8%). During the follow-up period (mean 10.2 months), the stents remained in place successfully for 6 to 8 weeks in seven patients (31.8%). Among the 15 patients (62.5%) with stent migration, seven (46.6%) showed continued symptomatic improvement without recurrence of obstructive symptoms. Conclusions Despite the symptomatic improvement, temporary SEMS placement is premature as an effective therapeutic tool for benign pyloric stenosis unless a novel stent is developed to prevent migration. PMID:23898381

Choi, Won Jae; Park, Jain; Lim, Eun-Hye; Joo, Moon Kyung; Yun, Jae-Won; Noh, Hyejin; Kim, Sung Ho; Choi, Woo Seok; Lee, Beom Jae; Kim, Ji Hoon; Yeon, Jong Eun; Kim, Jae Seon; Byun, Kwan Soo; Bak, Young-Tae

2013-01-01

67

Roles of sphincter of Oddi motility and serum vasoactive intestinal peptide, gastrin and cholecystokinin octapeptide  

PubMed Central

AIM: To investigate roles of sphincter of Oddi (SO) motility played in pigment gallbladder stone formation in model of guinea pigs. METHODS: Thirty-four adult male Hartley guinea pigs were divided randomly into two groups: the control group and pigment stone group. The pigment stone group was divided into 4 subgroups with 6 guinea pigs each according to time of sacrifice, and were fed a pigment lithogenic diet and sacrificed after 3, 6, 9 and 12 wk. SO manometry and recording of myoelectric activity of the guinea pigs were obtained by multifunctional physiograph at each stage. Serum vasoactive intestinal peptide (VIP), gastrin and cholecystokinin octapeptide (CCK-8) were detected at each stage in the process of pigment gallbladder stone formation by enzyme-linked immunosorbent assay. RESULTS: The incidence of pigment gallstone formation was 0%, 0%, 16.7% and 66.7% in the 3-, 6-, 9- and 12-wk group, respectively. The frequency of myoelectric activity decreased in the 3-wk group. The amplitude of myoelectric activity had a tendency to decrease but not significantly. The frequency of the SO decreased significantly in the 9-wk group. The SO basal pressure and common bile duct pressure increased in the 12-wk group (25.19 ± 7.77 mmHg vs 40.56 ± 11.81 mmHg, 22.35 ± 7.60 mmHg vs 38.51 ± 11.57 mmHg, P < 0.05). Serum VIP was significantly elevated in the 6- and 12-wk groups and serum CCK-8 was decreased significantly in the 12-wk group. CONCLUSION: Pigment gallstone-causing diet may induce SO dysfunction. The tension of the SO increased. The disturbance in SO motility may play a role in pigment gallstone formation, and changes in serum VIP and CCK-8 may be important causes of SO dysfunction. PMID:24782626

Zhang, Zhen-Hai; Qin, Cheng-Kun; Wu, Shuo-Dong; Xu, Jian; Cui, Xian-Ping; Wang, Zhi-Yi; Xian, Guo-Zhe

2014-01-01

68

Erectile dysfunctions.  

PubMed

Erectile dysfunction is one of the prime challenges confronting the treating physician. Its prevalence is directly proportional to aging. It is imperative to comprehend the intricate mechanism of erection in order to individualize the approach to management. Thus, it is appropriate to evaluate the etiology of erectile dysfunction. Normal aging, as well as psychogenic, vascular, neurogenic, and endocrinologic causes and/or those due to structural abnormalities of the penis should be considered when evaluating details to determine its probable cause. An increasing use of drugs, a legacy of civilization, has considerably compounded the problem. Therapy for erectile dysfunction, apart from psychosexual counseling, includes medical treatment by alpha adrenoceptor antagonists, dopamine agonists, phosphodiesterase type 5 inhibitors, sublingual apomorphine hydrochloride, or hormone therapy. Transdermal or transurethral corporeal drug delivery are other possible treatment modalities. Vacuum devices and surgical approaches are considered relevant only in refractory cases. PMID:14673246

Sehgal, Virendra N; Srivastava, Govind

2003-01-01

69

[Erectile dysfunction].  

PubMed

Erectile Dysfunction is one of the most prevalent sexual disorders in men. According to the current literature the prevalence is about 16% for all men. The diagnostic workup of a patient suffering from E.D. is a detailed anamnesis, a physical and endocrinological evaluation and the suggestion of the optimal therapeutic treatment. The therapeutic application of PDE-5 inhibitors has made the therapy of E.D. much easier. It is a safe and highly efficient therapeutic option. But man must not forget that in severe cases of erectile dysfunction, the application of SKAT therapy, penile implants or vacuum devices might be necessary. Since a functioning sex life is important not only for the men, but also for the couple, a more open attitude of us, physicians, is desirable to help more men who suffer from this sexual dysfunction. PMID:19997838

Esterbauer, Brigitte; Jungwirth, Andreas

2009-01-01

70

Gustatory dysfunction  

PubMed Central

Tastes in humans provide a vital tool for screening soluble chemicals for food evaluation, selection, and avoidance of potentially toxic substances. Taste or gustatory dysfunctions are implicated in loss of appetite, unintended weight loss, malnutrition, and reduced quality of life. Dental practitioners are often the first clinicians to be presented with complaints about taste dysfunction. This brief review provides a summary of the common causes of taste disorders, problems associated with assessing taste function in a clinical setting and management options available to the dental practitioner. PMID:25210380

Maheswaran, T.; Abikshyeet, P.; Sitra, G.; Gokulanathan, S.; Vaithiyanadane, V.; Jeelani, S.

2014-01-01

71

Refractoriness of urethral striated sphincter during voiding: studies with afferent pudendal reflex arc stimulation in male subjects.  

PubMed

To assess the excitability of the striated sphincter under normal and abnormal conditions, electrostimulation of the periurethral striated sphincter via the dorsal nerve of the penis was done with the patient at rest and during voiding. Monitoring of simultaneous intravesical and intramembranous urethral pressures, and electromyographic responses of the striated sphincter was performed under fluoroscopic guidance in 14 male subjects. The urethral striated sphincter attained a state of relative refractoriness during detrusor contraction (voiding phase) and greater amounts of afferent stimulation were required to elicit sphincter contractile activity compared to the amounts required during resting states. Under conditions of a hyperactive detrusor with synergic voiding, the amounts of stimulation required to elicit striated sphincter responses were higher than those required in normal subjects. On the other hand, under conditions of striated sphincter dyssynergia, minute amounts of afferent stimulation were enough to produce sphincter contraction during voiding. PMID:3959194

Dyro, F M; Yalla, S V

1986-04-01

72

Quantification of Gastric Mill Network Effects on a Movement Related Parameter of Pyloric Network Output in the Lobster  

E-print Network

Output in the Lobster JEFF B. THUMA AND SCOTT L. HOOPER Neuroscience Program, Department of Biological parameter of pyloric network output in the lobster. J Neurophysiol 87: 2372­2384, 2002; 10.1152/jn.00476 mill cycle [as measured from the beginning of Gastric Mill (GM) neuron bursts] in the lobster, Panu

Hooper, Scott

73

Starvation and refeeding effects on pyloric caeca structure of Caspian salmon (Salmo trutta caspius, Kessler 1877) juvenile.  

PubMed

Effect of starvation and refeeding on the structure of pyloric caeca was studied in the juveniles of Caspian Sea salmon. Juveniles (average body weight 12±0.1g) were subjected to four levels of feeding: full-fed for 6 weeks (FFF), 3 weeks fed and 3 weeks following starvation (FS), 3 weeks starved and 3 weeks fed (SF), and full-starved (SSS) for 6 weeks. Light microscopic studies showed significant reduction (p<0.05) in the enterocytes height and number, villus length, epithelial area and pyloric caeca total area in starved groups as compared to control group. These reductions were more significant (p<0.05) in long term starved group (SSS) than short term starved group (FS). Additionally, refeeding increased pyloric caeca size and enterocyte's number in SF group whereas, the epithelial total area and villus length did not reach the same area and length as control group. Results indicated that in Caspian Sea salmon juveniles food deprivation and consuming of food source, adversely affected the tissue of pyloric caeca while refeeding can be effective on healing tissue damage. PMID:23477933

Emadi Shaibani, Mina; Mojazi Amiri, Bagher; Khodabandeh, Saber

2013-06-01

74

ERCP, biliary crystal analysis, and sphincter of Oddi manometry in idiopathic recurrent pancreatitis  

Microsoft Academic Search

Background: This study investigated the role of ERCP, analysis of bile for microcrystals, and sphincter of Oddi manometry in idiopathic recurrent pancreatitis. Methods: One hundred twenty-six patients met criteria for idiopathic recurrent pancreatitis. Patients with a normal ERCP underwent sphincter of Oddi manometry and analysis of bile. Bile was also collected in patients with papillary stenosis (defined as ductal dilation

Madhukar Kaw; George J. Brodmerkel

2002-01-01

75

Muscle precursor cells for the restoration of irreversibly damaged sphincter function.  

PubMed

Multiple modalities, including injectable bulking agents and surgery, have been used to treat stress urinary incontinence. However, none of these methods is able to fully restore normal striated sphincter muscle function. In this study, we explored the possibility of achieving functional recovery of the urinary sphincter muscle using autologous muscle precursor cells (MPCs) as an injectable, cell-based therapy. A canine model of striated urinary sphincter insufficiency was created by microsurgically removing part of the sphincter muscle in 24 dogs. Autologous MPCs were obtained, expanded in culture, and injected into the damaged sphincter muscles of 12 animals. The animals were followed for up to 6 months after injection, and urodynamic studies, functional organ bath studies, ultrastructural and histological examinations were performed. Animals receiving MPC injections demonstrated sphincter pressures of approximately 80% of normal values, while the pressures in the control animals without cells dropped and remained at 20% of normal values. Histological analysis indicated that the implanted cells survived and formed tissue, including new innervated muscle fibers, within the injected region of the sphincter. These results indicate that autologous muscle precursor cells may be able to restore otherwise irreversibly damaged urinary sphincter function clinically. PMID:22236637

Eberli, Daniel; Aboushwareb, Tamer; Soker, Shay; Yoo, James J; Atala, Anthony

2012-01-01

76

Influence of pudendal block on the function of the anal sphincters  

Microsoft Academic Search

The function of the anal sphincters has been studied by obtaining continuous recordings of the pressure in the anal canal and the electromyographic activity in the striated sphincter muscles during expansion of the ampulla recti by means of an air balloon. Ten healthy subjects were examined before and after the striated muscles had been entirely paralysed by bilateral pudendal block,

B Frenckner; C V Euler

1975-01-01

77

Prospective study of the extent of internal anal sphincter division during lateral sphincterotomy  

Microsoft Academic Search

PURPOSE: The aim of lateral internal anal sphincterotomy when treating anal fissure is to divide the distal one-third to one-half of the internal anal sphincter. This study aimed to evaluate prospectively the extent of disruption to the internal anal sphincter following lateral anal internal sphincterotomy and also to establish the prevalence of symptoms of anal incontinence in these patients. METHODS:

Abdul H. Sultan; Michael A. Kamm; R. John Nicholls; Clive I. Bartram

1994-01-01

78

Neuroscience Letters 244 (1998) 137-140 Urethral pudendal afferent-evoked bladder and sphincter reflexes  

E-print Network

reflexes in decerebrate and acute spinal cats Susan J. Shefchyk*, R.R. Buss Department of Physiology of the urethral sensory pudendal nerve in decerebrate or acute spinal cats was used to evoke micturition reflexes sphincter activity and contribute to both guarding-like reflexes as well as suppression of sphincter

Manitoba, University of

79

Effect of head position on the dynamics of the upper esophageal sphincter and pharynx  

Microsoft Academic Search

Due to limitations in available technology it has been difficult to obtain data on upper esophageal sphincter (UES) and pharyngeal (P) function under varying physiologic conditions. We used a manometry system with solid-state intraluminal transducers, including a circumferential sphincter transducer, and computer analysis to measure pressure changes in UES and P during wet (5 ml H2O) swallows as the head

June A. Castell; Donald O. Castell; Adeline R. Schultz; Susan Georgeson

1993-01-01

80

Pyloric stenosis  

MedlinePLUS

... The surgery is called pyloromyotomy. If putting the infant to sleep for surgery is not safe, a device called an endoscope with a tiny balloon at the end is used. The balloon is ... In infants who cannot have surgery, tube feeding or medicine ...

81

The Glands of the Stomach in Relation to Pernicious Anæmia; with Special Reference to the Glands in the Pyloric Region  

PubMed Central

The researches have had in view the anatomical localization of the anti-anæmic factor (Castle's “intrinsic factor”) in the stomach. As the pig's stomach is peculiarly constructed, having a so-called cardiac-gland region, a fundus-gland region and a pyloric gland region continued in the glands of Brunner in the duodenum, preparations have been made from each of these regions, and tests of the effectiveness of each of these separate portions have been made in cases of pernicious anæmia. It has previously been pointed out (Meulengracht and Schiødt) that the production of hydrochloric acid, pepsin and rennin was confined to the glands of the fundus region (peptic glands) with their oxyntic cells and chief cells. The experiments showed that the extract of the fundus-gland portion was inactive in cases of pernicious anæmia, that of the so-called cardiac-gland portion was mildly active, that of the pyloric-gland portion was strongly active, and that of the duodenal portion was also strongly active. The feebler activity of the cardiac portion might be shown to be a result of the smaller number of glands to the unit area in that region. The conclusion drawn from the experiments is that the so-called cardiac glands, the pyloric glands and the Brunner glands in the duodenum, which anatomically may be said to be very nearly identical, may also be taken to be functionally identical, at any rate with regard to the production of the anti-anæmic factor. This collective gland region, which it is proposed to call the pyloric-gland region, is the site of the production of the anti-anæmic factor. There is thus attributed to these glands a definite, well-defined and vitally important function. It is further concluded from the experiments that pernicious anæmia in human beings is due to atrophy and inactivity of that part of the stomach which comprises the pyloric-gland region. The experiments may thus be said to have anatomically localized pernicious anæmia in human beings. Experimental pernicious anæmia will presumably be producible by the deliberate removal of the pyloric-gland region. Stomach preparations for the treatment of pernicious anæmia will with advantage be producible from the pyloric-gland region alone. ImagesFig. 1Fig. 3Fig. 4Fig. 5Curve 1Curve 2Curve 3Curve 4Curve 5Curve 7Curve 8Curve 9Curve 10Curve 11Curve 12Curve 13Curve 14Curve 15Curve 16Fig. 8Fig. 9Fig. 11Fig. 12Curve 17Curve 18 PMID:19990300

Meulengracht, E.

1935-01-01

82

The relation of sensation in the anal canal to the functional anal sphincter: a possible factor in anal continence  

Microsoft Academic Search

In normal subjects the length of the functional anal sphincter has been compared with the extent of sensation to light touch in the anal canal. At rest, the sphincteric zone was the longer. On distension of the rectum, a decrease in pressure in the anal canal so shortened the functional sphincter that intrarectal pressure extended down to contact the sensory

H. L. Duthie; R. C. Bennett

1963-01-01

83

The epidemiology of infantile hypertrophic pyloric stenosis in Sweden 1987-96  

PubMed Central

AIMS—To find out whether the incidence of infantile hypertrophic pyloric stenosis (IHPS) has changed over the past decade, and if so, to investigate possible contributory factors.?METHODS—All infants undergoing pyloromyotomy for IHPS in Sweden between 1987 and 1996 were studied. Using the national patient registers the yearly incidence was determined and evaluated in relation to sex, latitude, urbanisation, and type of surroundings by use of a Poisson model.?RESULTS—There was a substantial decline from 2.7/1000 to 0.85/1000 over the time period. The incidence in the south was almost three times greater than in the north.?CONCLUSION—The declining incidence and geographical difference suggest that environmental factors are of importance in this disorder.?? PMID:11668097

Hedback, G; Abrahamsson, K; Husberg, B; Granholm, T; Oden, A

2001-01-01

84

Laparoscopic gastric resection with natural orifice specimen extraction for postulcer pyloric stenosis  

PubMed Central

Although natural orifice specimen extraction is now relatively widely performed, there have been no reports on gastric resection with specimen extraction through the transgastric route for peptic ulcer disease. A hybrid technique of the laparoscopic and endoscopic approach is presented in the case of a 58-year old male patient. Preoperative gastric fibroscopy showed postulcer pyloric and antral stenosis. Laparoscopic exploration confirmed gastric enlargement. Laparoscopic two-thirds gastrectomy was performed. The staple line suture of the residual stomach was excised and the specimen was extracted through the esophagus and mouth with a gastroscope. Finally, the residual stomach was closed again using linear endostaplers. Reconstruction was performed according to the Roux-en-Y method. Gastric resection using natural orifice specimen extraction (NOSE) may be a feasible operative procedure. The NOSE with the combination of standard laparoscopy and specimen extraction through a natural orifice can be considered as a bridge to natural orifice translumenal endoscopic surgery. PMID:25097701

Dostalik, Jan; Gunkova, Petra; Mazur, Miloslav; Mrazek, Tomas

2014-01-01

85

Detrusor urethral sphincter dyssynergia: micturitional vesicourethral pressure profile patterns.  

PubMed

Vesicourethral static pressure recordings were attempted in patients with detrusor urethral sphincter dyssynergia. The technique consisted of recording vesicourethral pressures at successive points, commencing in the lower segment of the bladder during micturition. A small catheter with side holes was used for this purpose and static (lateral) pressure profile recordings were attempted during voiding. Successful static pressure recordings were obtained only in those patients who could expel urine as uninterrupted stream. Patients who could not void or those who could void only with interrupted stream have demonstrated profile patterns that required careful interpretation. The accuracy of urodynamic interpretation also depended upon careful clinical evaluation and awareness of the built-in artifacts of the technique. PMID:7176062

Yalla, S V; Yap, W; Fam, B A

1982-11-01

86

Incontinence, bladder neck mobility, and sphincter ruptures in primiparous women  

PubMed Central

Objective To compare the function of the pelvic floor in primiparae before and during pregnancy with the status post partum concerning symptoms of incontinence, sphincter ruptures, bladder-neck mobility and the influence of the different modes of deliveries. Methods Questionnaire evaluating symptoms of urinary and anal incontinence in nulliparous women before and after delivery and correlating these symptoms with functional changes of the pelvic floor based on a careful gynaecologic examination as well as perineal and endoanal ultrasound. Results 112 women were included in our study and came for the first visit, 99 women returned for follow-up 6 months after childbirth. Stress and flatus incontinence significantly increased from before pregnancy (3 and 12%) to after childbirth (21 and 28%) in women with spontaneous delivery or vacuum extraction. No new symptoms occurred after c-section. There was no significant difference between the bladder neck position before and after delivery. The mobility of the bladder neck was significantly higher after vaginal delivery using a vacuum extraction compared to spontaneous delivery or c-section. The bladder neck in women with post partum urinary stress incontinence was significantly more mobile than in continent controls. The endoanal ultrasound detected seven occult sphincter defects without any correlation to symptoms of anal incontinence. Conclusion Several statistically significant changes of the pelvic floor after delivery were demonstrated. Spontaneous vaginal delivery or vacuum extraction increases the risk for stress or anal incontinence, delivery with vacuum extraction leads to higher bladder neck mobility and stress incontinent women have more mobile bladder necks than continent women. PMID:20696633

2010-01-01

87

Heme oxygenase-1 upregulation modulates tone and fibroelastic properties of internal anal sphincter.  

PubMed

A compromise in the internal anal sphincter (IAS) tone and fibroelastic properties (FEP) plays an important role in rectoanal incontinence. Herein, we examined the effects of heme oxygenase (HO)-1 upregulation on these IAS characteristics in young rats. We determined the effect of HO-1 upregulator hemin on HO-1 mRNA and protein expressions and on basal IAS tone and its FEP before and after HO-1 inhibitor tin protoporphyrin IX. For FEP, we determined the kinetics of the IAS smooth muscle responses, by the velocities of relaxation, and recovery of the IAS tone following 0 Ca(2+) and electrical field stimulation. To characterize the underlying signal transduction for these changes, we determined the effects of hemin on RhoA-associated kinase (RhoA)/Rho kinase (ROCK) II, myosin-binding subunit of myosin light chain phosphatase 1, fibronectin, and elastin expression levels. Hemin increased HO-1 mRNA and protein similar to the increases in the basal tone, and in the FEP of the IAS. Underlying mechanisms in the IAS characteristics are associated with increases in the genetic and translational expressions of RhoA/ROCKII, and elastin. Fibronectin expression levels on the other hand were found to be decreased following HO-1 upregulation. The results of our study show that the hemin/HO-1 system regulates the tone and FEP of IAS. The hemin/HO-1 system thus provides a potential target for the development of new interventions aimed at treatment of gastrointestinal motility disorders, specifically the age-related IAS dysfunction. PMID:25035109

Krishna, Chadalavada Vijay; Singh, Jagmohan; Kumar, Sumit; Rattan, Satish

2014-09-15

88

Long-term recording of external urethral sphincter EMG activity in unanesthetized, unrestrained rats.  

PubMed

The external urethral sphincter muscle (EUS) plays an important role in urinary function and often contributes to urinary dysfunction. EUS study would benefit from methodology for longitudinal recording of electromyographic activity (EMG) in unanesthetized animals, but this muscle is a poor substrate for chronic intramuscular electrodes, and thus the required methodology has not been available. We describe a method for long-term recording of EUS EMG by implantation of fine wires adjacent to the EUS that are secured to the pubic bone. Wires pass subcutaneously to a skull-mounted plug and connect to the recording apparatus by a flexible cable attached to a commutator. A force transducer-mounted cup under a metabolic cage collected urine, allowing recording of EUS EMG and voided urine weight without anesthesia or restraint. Implant durability permitted EUS EMG recording during repeated (up to 3 times weekly) 24-h sessions for more than 8 wk. EMG and voiding properties were stable over weeks 2-8. The degree of EUS phasic activity (bursting) during voiding was highly variable, with an average of 25% of voids not exhibiting bursting. Electrode implantation adjacent to the EUS yielded stable EMG recordings over extended periods and eliminated the confounding effects of anesthesia, physical restraint, and the potential for dislodgment of the chronically implanted intramuscular electrodes. These results show that micturition in unanesthetized, unrestrained rats is usually, but not always, associated with EUS bursting. This methodology is applicable to studying EUS behavior during progression of gradually evolving disease and injury models and in response to therapeutic interventions. PMID:24990895

LaPallo, Brandon K; Wolpaw, Jonathan R; Chen, Xiang Yang; Carp, Jonathan S

2014-08-15

89

Urinary dysfunction in multiple sclerosis.  

PubMed

We aimed to determine the prevalence of urinary symptoms and complications in multiple sclerosis (MS) and to investigate the correlation of these symptoms and complications with urodynamic findings and disease characteristics (primary progressive, relapsing-remitting and secondary progressive). Fifty-two patients with MS were enrolled in the study. Patients were divided into three clinical types: primary progressive, relapsing-remitting and secondary progressive. Urological symptoms and complications were recorded. Each patient underwent a urodynamic investigation. Patients were evaluated for overall disability using the Expanded Disability Status Scale (EDSS). We found that 22 patients had primary progressive, 18 patients had relapsing-remitting and 12 patients had secondary progressive MS. Urgency was the most frequent urinary symptom (65%). Urinary infection was the most frequent urinary complication (15%). Detrusor hyperreflexia was found to be the main bladder dysfunction (27%). Detrusor sphincter dyssynergia was found in 25% of patients, and detrusor hyporeflexia was detected in 6%. No relationship was found between urinary symptoms and urodynamic abnormalities (p>0.05) and between urinary complications and urodynamic findings (p>0.05). No significant correlation was found between disease characteristics and urinary symptoms, urinary complications or urodynamic findings (p>0.05). We suggest that the assessment of urological symptoms and urodynamic evaluation is critical for evaluating quality of life in MS. PMID:19560927

Nakipoglu, G F; Kaya, A Z; Orhan, G; Tezen, O; Tunc, H; Ozgirgin, N; Ak, F

2009-10-01

90

[Clinical evaluation of covered self-expandable metallic stent for unresectable malignant stomach pyloric region and duodenal obstruction].  

PubMed

We evaluated palliative treatment for unresectable malignant stomach pyloric region and the duodenal obstruction using covered self-expandable metallic stent (SEMS). Fifty-seven patients (26 stomach pyloric stenosis, 31 duodenal stenosis) were underwent palliative treatment using covered SEMS. The covered SEMS was Ultraflex stent for esophageal obstruction. The covered SEMS was successfully indwelled in the target region in 56 patients. The patients became able to ingest orally after a mean of 2 days, and 96% of the patients (54/56) became able to eat solid or semi-solid diets later. The SEMS obstruction by tumor ingrowth or hyperplasia was not occurred, so SEMS was maintenance-free. We concluded covered SEMS was useful palliative treatment because it prevented SEMS obstruction by tumor ingrowth or hyperplasia and it was maintenance-free. PMID:16629459

Hayashi, Kazuki; Okayama, Yasutaka; Ueno, Kouichiro; Miyabe, Katsuyuki; Naitoh, Itaru; Hirai, Masaaki; Kitajima, Yasuhiro; Ban, Tesshin; Gotoh, Kazuo; Yamada, Tomonori; Sano, Hitoshi; Nakazawa, Takahiro; Ohara, Hirotaka; Joh, Takashi; Itoh, Makoto

2006-04-01

91

Treatment of detrusor-sphincter dyssynergia by pudendal nerve block in patients with spinal cord injury  

Microsoft Academic Search

Tsai S-J, Lew HL, Date E, Bih L-I. Treatment of detrusor-sphincter dyssynergia by pudendal nerve block in patients with spinal cord injury. Arch Phys Med Rehabil 2002;83:714-7. Objective: To study the effects of pudendal nerve block with phenol on detrusor-sphincter dyssynergia in patients with spinal cord injury (SCI). Design: Before-after trial performed by using a consecutive sample. Setting: Rehabilitation hospital

Su-Ju Tsai; Henry L. Lew; Elaine Date; Liu-Ing Bih

2002-01-01

92

Decreased rate of obstetrical anal sphincter laceration is associated with change in obstetric practice  

Microsoft Academic Search

A study was conducted to describe the rate of obstetrical anal sphincter laceration in a large cohort of women and to identify\\u000a the characteristics associated with this complication. Data from all vaginal deliveries occurring between January 1996 and\\u000a December 2004 at one institution were used to compare women with and without anal sphincter lacerations. Among 16,667 vaginal\\u000a deliveries, 1,703 (10.2%)

Steven M. Minaglia; Begüm Özel; Nicole M. Gatto; Lisa Korst; Daniel R. Mishell Jr; David A. Miller

2007-01-01

93

Effect of general anaesthesia on transient lower oesophageal sphincter relaxations in the dog.  

PubMed

This report investigates the hypothesis that gastro-oesophageal flow is modulated by central nervous activity. The hypothesis was examined using the canine model in which gastro-oesophageal flow was stimulated by gastric insufflation of air at 80 ml/min and central nervous depression was produced with the anaesthetic agents thiopentone, nitrous oxide and halothane. Duplicate paired studies were performed in four dogs, either unsedated or anaesthetized. Gastro-oesophageal flow was assessed manometrically by a sleeve catheter assembly and by pH electrode. Gastric compliance was assessed by inflation of a thin-walled, plastic bag. Transient lower oesophageal sphincter relaxation, the dominant mechanism of retrograde trans-sphincter flow in unsedated animals, was abolished by general anaesthesia. Retrograde flow of gas across the lower oesophageal sphincter in anaesthetized animals eventually occurred, but only after massive gastric distension and elevation of gastric pressure to lower oesophageal sphincter pressure. The effects observed could not be explained by a direct action of anaesthetic on the lower oesophageal sphincter or on the gastric wall. It is proposed that general anaesthesia results in blockade of the neural pathway responsible for transient lower oesophageal sphincter relaxation by withdrawal of facilitative higher centre activity. The findings have implications for the use of sedation in experimental studies on factors which control gastro-oesophageal reflux, and clinical application to the risk of tracheal aspiration during general anaesthesia. PMID:3250418

Cox, M R; Martin, C J; Dent, J; Westmore, M

1988-10-01

94

Sexual Dysfunction and Infertility  

MedlinePLUS

... asrm.org PATIENT FACT SHEET Sexual Dysfunction and Infertility You probably don't realize how many people ... talk to a sex therapist. Sexual dysfunction and infertility Sexual dysfunction may cause problems getting pregnant (infertility). ...

95

[A case of unresectable gastric cancer with pyloric stenosis which was resectable by chemotherapy after gastrojejunostomy].  

PubMed

A man in his fifties was referred to our hospital for anorexia and vomiting. Upper gastrointestinal endoscopy showed a gastric cancer (Borrmann Type 3) with pyloric stenosis. We performed gastrojejunostomy to allow oral intake for a tumor invading the pancreas head (cT4bN1H0P0CY1, Stage IV). After the operation, systemic chemotherapy with S-1 (120 mg/m²) was administered from July 2007, which caused grade 3 mucositis oral and drug rash after one week. Then, bi- weekly administration of CPT-11 (60 mg/m²) and CDDP (30 mg/m²) was started from August 2007 as second-line chemotherapy. The treatment was repeated for 14 courses till an allergic reaction happened. A weekly paclitaxel (PTX) therapy (80 mg/m²) was started from January 2009 as third-line. After 6 courses, CT showed that direct invasion to the pancreas was not clear any more, so a distal gastrectomy with D1 lymphadenectomy was performed on August 2009 (ypT3N- 1P0CY0, Stage IIB). The patient received 9 courses of weekly PTX therapy and after that the treatment has been discontinued. Recurrence was not observed for 48 months after an initial treatment. PMID:22202374

Miyo, Masaaki; Iijima, Shohei; Makari, Yoichi; Kato, Aya; Sakamoto, Takuya; Doi, Takashi; Hoshi, Minako; Miyake, Yasuhiro; Oshima, Satoshi; Kato, Takeshi; Kurokawa, Eiji; Kikkawa, Nobuteru

2011-11-01

96

Standardization of anal sphincter EMG: technique of needle examination.  

PubMed

The external anal sphincter (EAS) anatomy is complex, and no exact technique of needle electrode insertion into it for electromyography (EMG) has been described. To define optimal positions for needle electrode insertions, EAS muscle topography was studied by concentric needle EMG. Fifteen women without uroneurological disorders were examined. Perpendicular insertions were made superficially (just under the mucosa) at the mucocutaneous junction, 5 and 10 mm more proximally (toward the anus), and at the anal orifice. In addition, at the anal orifice, deeper insertions were made. Superficially, EMG activity was detected at the mucocutaneous junction in 9 (60%) subjects. In the remaining 6, the muscle was found either 5 mm (in 5) or 10 mm (in 1) more centrally. At the anal orifice, superficial EMG activity was present in 67% of women. On deep insertion (15-25 mm) at the anal orifice, muscle was always present. It is suggested that, in further studies, the portions of the EAS muscle examined should be specified. PMID:10086902

Podnar, S; Rodi, Z; Lukanovic, A; Trsinar, B; Vodusek, D B

1999-03-01

97

Physioanatomic entirety of external anal sphincter with bulbocavernosus muscle.  

PubMed

Stimulation of the glans penis evokes contraction of both the bulbocavernosus muscles (BCM) and the external anal sphincter (EAS). This synchronous contraction of the two muscles led us to study their physioanatomic relationship and possible role in erection and ejaculation. Fifteen male cadavers were studied (8 neonatal deaths and 7 adults; mean age 48 years) by dissection. The bulbocavernosus reflex action was performed in 12 healthy male volunteers (mean age 37 years) before and after anesthetizing the EAS. The response of the EAS and BCM to inferior rectal nerve stimulation was assessed in 6 men (mean age 41 years). The superficial fibers of the base loop of the EAS extended forward to the penile bulb where they were arranged into 3 groups: 1 median and 2 lateral. The median fibers, or the "retractor penis muscle," were found inserted into the corpora cavernosa and the lateral fibers, or the "compressor bulbae muscle," into the perineal membrane. Upon glans penis stimulation, both the EAS and BCM contracted synchronously with similar latency and action potentials. During EAS anesthesia, the two muscles did not respond to glans penis stimulation. They contracted simultaneously with similar latency and action potentials upon inferior rectal nerve stimulation. The BCM is an integral part of the EAS, and the muscle in its entirety is appropriately named "anogenital muscle." The muscle plays a dual and synchronous role in fecal control and sexual response. PMID:9973145

Shafik, A

1999-01-01

98

Preventing kidney injury in children with neurogenic bladder dysfunction.  

PubMed

The most common cause of neurogenic bladder dysfunction (NBD) in newborn infants is myelomeningocele. The pathophysiology almost always involves the bladder detrusor sphincter dyssynergy (DSD), which if untreated can cause severe and irreversible damage to the upper and lower urinary tracts. Early diagnosis and adequate management of NBD is critical to prevent both renal damage and bladder dysfunction and to reduce chances for the future surgeries. Initial investigation of the affected newborn infant includes a renal and bladder ultrasound, measurement of urine residual, determination of serum creatinine level, and urodynamics study. Voiding cystogram is indicated when either hydronephrosis or DSD is present. The main goal of treatment is prevention of urinary tract deterioration and achievement of continuance at an appropriate age. Clean intermittent catheterization (CIC) in combination with anticholinergic (oxybutynin) and antibiotics are instituted in those with high filling and voiding pressures, DSD and/or high grade reflux immediately after the myelomeningocele is repaired. Botulium toxin-A injection into detrusor is a safe alternative in patients with insufficient response or significant side effects to anticholinergic (oral or intravesical instillation) therapy. Surgery is an effective alternative in patients with persistent detrusor hyperactivity and/or dyssynergic detrusor sphincter despites of the CIC and maximum dosage of anticholinergic therapy. Children with NBD require care from a multidisciplinary team approach consisting of pediatricians, neurosurgeon, urologist, nephrologists, orthopedic surgeon, and other allied medical specialists. PMID:24498490

Larijani, Faezeh Javadi; Moghtaderi, Mastaneh; Hajizadeh, Nilofar; Assadi, Farahnak

2013-12-01

99

Preventing Kidney Injury in Children with Neurogenic Bladder Dysfunction  

PubMed Central

The most common cause of neurogenic bladder dysfunction (NBD) in newborn infants is myelomeningocele. The pathophysiology almost always involves the bladder detrusor sphincter dyssynergy (DSD), which if untreated can cause severe and irreversible damage to the upper and lower urinary tracts. Early diagnosis and adequate management of NBD is critical to prevent both renal damage and bladder dysfunction and to reduce chances for the future surgeries. Initial investigation of the affected newborn infant includes a renal and bladder ultrasound, measurement of urine residual, determination of serum creatinine level, and urodynamics study. Voiding cystogram is indicated when either hydronephrosis or DSD is present. The main goal of treatment is prevention of urinary tract deterioration and achievement of continuance at an appropriate age. Clean intermittent catheterization (CIC) in combination with anticholinergic (oxybutynin) and antibiotics are instituted in those with high filling and voiding pressures, DSD and/or high grade reflux immediately after the myelomeningocele is repaired. Botulium toxin-A injection into detrusor is a safe alternative in patients with insufficient response or significant side effects to anticholinergic (oral or intravesical instillation) therapy. Surgery is an effective alternative in patients with persistent detrusor hyperactivity and/or dyssynergic detrusor sphincter despites of the CIC and maximum dosage of anticholinergic therapy. Children with NBD require care from a multidisciplinary team approach consisting of pediatricians, neurosurgeon, urologist, nephrologists, orthopedic surgeon, and other allied medical specialists. PMID:24498490

Larijani, Faezeh Javadi; Moghtaderi, Mastaneh; Hajizadeh, Nilofar; Assadi, Farahnak

2013-01-01

100

Preoperative Therapy for Lower Rectal Cancer and Modifications in Distance From Anal Sphincter  

SciTech Connect

Purpose: To assess the frequency and magnitude of changes in lower rectal cancer resulting from preoperative therapy and its impact on sphincter-saving surgery. Preoperative therapy can increase the rate of preserving surgery by shrinking the tumor and enhancing its distance from the anal sphincter. However, reliable data concerning these modifications are not yet available in published reports. Methods and Materials: A total of 98 cases of locally advanced cancer of the lower rectum (90 Stage uT3-T4N0-N+ and 8 uT2N+M0) that had undergone preoperative therapy were studied by endorectal ultrasonography. The maximal size of the tumor and its distance from the anal sphincter were measured in millimeters before and after preoperative therapy. Surgery was performed 6-8 weeks after therapy, and the histopathologic margins were compared with the endorectal ultrasound data. Results: Of the 90 cases, 82.5% showed tumor downsizing, varying from one-third to two-thirds or more of the original tumor mass. The distance between the tumor and the anal sphincter increased in 60.2% of cases. The median increase was 0.73 cm (range, 0.2-2.5). Downsizing was not always associated with an increase in distance. Preserving surgery was performed in 60.6% of cases. It was possible in nearly 30% of patients in whom the cancer had reached the anal sphincter before the preoperative therapy. The distal margin was tumor free in these cases. Conclusion: The results of our study have shown that in very low rectal cancer, preoperative therapy causes tumor downsizing in >80% of cases and in more than one-half enhances the distance between the tumor and anal sphincter. These modifications affect the primary surgical options, facilitating or making sphincter-saving surgery possible.

Gavioli, Margherita [Divisione di Chirurgia II, Nuovo Ospedale Civile S. Agostino-Estense, Modena (Italy)], E-mail: gavioli.margherita@libero.it; Losi, Lorena [Instituto di Anatomia Patologica, Universita di Modena e Reggio Emilia, Modena (Italy); Luppi, Gabriele; Iacchetta, Francesco; Zironi, Sandra; Bertolini, Federica [Dipartimento di Oncologia, Universita di Modena e Reggio Emilia, Modena (Italy); Falchi, Anna Maria; Bertoni, Filippo [Unita di Radioterapia Oncologica, Universita di Modena e Reggio Emilia, Modena (Italy); Natalini, Gianni [Divisione di Chirurgia II, Nuovo Ospedale Civile S. Agostino-Estense, Modena (Italy)

2007-10-01

101

Expression of serotonin receptors in human lower esophageal sphincter  

PubMed Central

Serotonin (5-HT) is a neurotransmitter and vasoactive amine that is involved in the regulation of a large number of physiological functions. The wide variety of 5-HT-mediated functions is due to the existence of different classes of serotonergic receptors in the mammalian gastrointestinal tract and nervous system. The aim of this study was to explore the expression of multiple types of 5-HT receptor (5-HT1AR, 5-HT2AR, 5-HT3AR, 5-HT4R, 5-HT5AR, 5-HT6R and 5-HT7R) in sling and clasp fibers from the human lower esophageal sphincter (LES). Muscle strips of sling and clasp fibers from the LES were obtained from patients undergoing esophagogastrectomy, and circular muscle strips from the esophagus and stomach were used as controls. Reverse transcription-polymerase chain reaction (RT-PCR), quantitative PCR and western blotting were used to investigate the expression of the various 5-HT receptor types. Messenger RNA for all seven 5-HT receptor types was identified in the sling and clasp fibers of the LES. At the mRNA level, the expression levels were highest for 5-HT3AR and 5-HT4R, and lowest for 5-HT5AR, 5-HT6R and 5-HT7R. At the protein level, the expression levels were highest for 5-HT3AR and 5-HT4R, followed by 5-HT1AR and 5-HT2AR; 5-HT7R was also detected at a low level. The expression of 5-HT5AR and 5-HT6R proteins was not confirmed. The results indicate that a variety of 5-HT receptor types can be detected in the human LES and probably contribute to LES function. PMID:25452775

LI, HE-FEI; LIU, JUN-FENG; ZHANG, KE; FENG, YONG

2015-01-01

102

Similarities and differences in the epidemiology of pyloric stenosis and SIDS.  

PubMed

Similar temporal declines in infantile hypertrophic pyloric stenosis (IHPS) and sudden infant death syndrome (SIDS) and other common features have led to hypotheses about a shared etiology. We carried out a population-based study to highlight similarities and differences between IHPS and SIDS. We used vital statistics and hospitalization data on all live births in Washington State, USA (1987-2009). Changes in IHPS and SIDS rates over time were quantified using rate ratios with 95 % confidence intervals (CI). The duration between birth and diagnosis of IHPS or SIDS was examined as a function of gestational age at birth. Logistic regression analysis was used to identify risk factors and quantify adjusted temporal trends (2000-2008). Although both IHPS and SIDS rates declined significantly between 1987 and 2008, the patterns and magnitude of the declines (40 and 74 %, respectively) were different. IHPS and SIDS shared risk factors such as maternal smoking and single parent status but other factors showed qualitatively or and quantitatively different associations. Primiparity was a risk factor for IHPS [odds ratio (OR) 1.24, 95 % CI 1.09-1.41], and a protective factor for SIDS (OR 0.44, 95 % CI 0.36-0.55), while male sex had a stronger association with IHPS (OR 4.51, 95 % CI 3.85-5.28 vs 1.36, 95 % CI 1.13-1.64). Both IHPS and SIDS showed significant inverse associations between gestational age at birth and chronologic age at diagnosis/death. IHPS and SIDS share some epidemiologic features and risk factors but other risk factors have qualitatively or quantitatively different effects and recent temporal trends in the two diseases are dissimilar. PMID:24337864

Lisonkova, Sarka; Joseph, K S

2014-09-01

103

Ghrelin as a novel locally produced relaxing peptide of the iris sphincter and dilator muscles.  

PubMed

Ghrelin is a recently described acylated peptide, which works as a somatosecretagogue and has described effects on the smooth, skeletal and cardiac muscle. We examined the production and effects of ghrelin on relaxation of the iris muscles. Contractile effects of 1-5 human ghrelin (frGhr, 10(-9)-6 x 10(-5)M) and 1-5 human des-octanoyl-ghrelin (d-frGhr; 10(-9)-6 x 10(-5)M) were tested on iris rabbit sphincter (n=11 frGhr; n=7 d-frGhr), dilator (n=6 frGhr; n=6 d-frGhr) and rat sphincter (n=6 frGhr; n=8 d-frGhr) precontracted muscles. On rabbit sphincter the effect of frGhr was also tested in presence of: i) L-NA (10(-5)M; n=7); ii) indomethacin (10(-5)M; n=7); iii) DLys(3)GHRP6 (10(-4)M; n=6); and iv) apamin+carybdotoxin (10(-6)M; n=6). Furthermore, on rabbit dilator the effect of frGhr was tested in presence of DLys(3)GHRP6 (10(-4)M; n=7). Finally, ghrelin mRNA production was assessed by "in situ" hybridization in Wistar rat eyes (n=8). In all muscles, frGhr promoted a concentration-dependent relaxation, maximal at 6 x 10(-5)M, 1.5-3 min after its addition, decreasing tension by 34.1+/-12.1%, 25.8+/-4.8% and 52.1+/-10.3% in the rabbit sphincter, dilator and rat sphincter, respectively. In the rabbit sphincter the relaxing effects of frGhr were: (i) enhanced in presence of DLys(3)GHRP6 (118.1+/-21.1%); (ii) blunted by indomethacin; and (iii) not altered by apamin+carybdotoxin (36.4+/-14.4%) or L-NA (52.4+/-11.4%). Relaxing effects of d-frGhr in rabbit (43.3+/-5.2%) and rat (77.1+/-15.3%) sphincter muscles were similar to those of frGhr. In rabbit dilator muscle, d-frGhr did not significantly alter active tension and the relaxing effect of frGhr was blunted by GHSR-1a blockage. Ghrelin mRNA was identified in iris posterior epithelium. In conclusion, ghrelin is a novel, locally produced, relaxing agent of iris dilator and sphincter muscles, an effect that is mediated by GHSR-1a in the former, but not in the latter. Furthermore, in the sphincter it seems to be mediated by prostaglandins, but not by NO or K(Ca) channels. PMID:16904667

Rocha-Sousa, A; Saraiva, J; Henriques-Coelho, T; Falcão-Reis, F; Correia-Pinto, J; Leite-Moreira, A F

2006-11-01

104

[An elastic ileostomy sphincter using an autologous small intestine muscle flap].  

PubMed

To achieve continence in ileostomies by free transplantation of small intestinal smooth muscle according to Schmidt failed frequently because of hemorrhagic necrosis of this graft. To safeguard intact vascularisation of the transplant flapped intestinal smooth muscle was used therefore in 15 dogs with ileostomy for sphincter replacements. Contrary to free grafts, histological studies of flapped small intestinal muscle cuffs show generally undisturbed healing. Furthermore, monitoring of electrical activities corroborate the viability of the graft. In continent animals, pressure studies show the presence of a high pressure zone in the sphincter canal. The positive pressure profile was maintained and contributes to appropriate closing of the ileostomy. Despite histological, manometrical and electrical criterions of viability of the artificial sphincter, nevertheless the continence achieved by this procedure remains limited because of the restricted ability to contract the small intestinal muscle and the lacking ileal compliance. PMID:6471993

Braun, J; Raguse, T; Hartung, R

1984-01-01

105

Smooth Muscle Enfoldment Internal Sphincter Construction after Intersphincteric Resection for Rectal Cancer  

PubMed Central

Objective To assess smooth muscle enfoldment and internal sphincter construction (SMESC) for improvement of continence after intersphincteric resection (ISR) for rectal cancer. Methods Twenty-four Bama miniature pigs were randomly divided into a conventional ISR group and experimental SMESC group, with 12 pigs in each group. The proximal sigmoid colon was anastomosed directly to the anus in the ISR group. In the SMESC group, internal sphincter construction was performed. At 12 weeks before and after surgery, rectal resting pressure and anal canal length were assessed. Three-dimensional ultrasound was used to determine the thickness of the internal sphincter. After the animals were sacrificed, the rectum and anus were resected and pathological examinations were performed to evaluate the differences in sphincter thickness and muscle fibers. Results All 24 animals in the SMESC group and the ISR group survived the surgery. Twelve weeks post-surgery, the rectal resting pressure, length of the anal high-pressure zone and the postoperative internal sphincter thickness for the ISR group were significantly lower than for the SMESC group. There was a thickened area (about 2 cm) above the anastomotic stoma among animals from the SMESC group; in addition, the smooth muscles were significantly enlarged and enfolded when compared to the ISR group. Conclusion This animal model study shows that the SMESC procedure achieved acceptable reconstruction of the internal anal neo-sphincter (IAN/S), without increasing surgical risk. However, the findings in this experimental animal model must be confirmed by clinical trials to determine the safety and efficacy of this procedure in clinical practice. PMID:24626174

Jin, Heiying; Zhang, Bei; Yao, Hang; Du, Yonghong; Wang, Xiaofeng; Leng, Qiang

2014-01-01

106

Radiofrequency energy delivery to the gastric cardia inhibits triggering of transient lower esophageal sphincter relaxation and gastroesophageal reflux in dogs  

Microsoft Academic Search

Background: Delivery of radiofrequency energy to the lower esophageal sphincter and gastric cardia is a new endoluminal technique proposed for the treatment of reflux disease. The mechanisms by which it achieves its effects are unclear. The study assessed the effect of radiofrequency energy delivery to the gastric cardia on the triggering of transient lower esophageal sphincter relaxations and gastroesophageal reflux

Michael S. Kim; Richard H. Holloway; John Dent; David S. Utley

2003-01-01

107

The Onuf's nucleus and the external anal sphincter muscles in amyotrophic lateral sclerosis and Shy-Drager syndrome  

Microsoft Academic Search

The anterior sacral horns and external anal sphincter muscle were examined histologically with special reference to Onuf's nucleus in amyotrophic lateral sclerosis (ALS) and Shy-Drager syndrome. Onuf's nucleus and the external anal sphincter muscles were well preserved in ALS, but in Shy-Drager syndrome both structures showed marked degenerative changes. These findings suggest that Onuf's nucleus does not belong to the

T. Mannen; M. Iwata; Y. Toyokura; K. Nagashima

1982-01-01

108

Location of bladder and urethral sphincter motoneurons in the male guinea pig (Cavia porcellus).  

PubMed

Although the guinea pig is used widely in experimental medical research, including in studies on micturition control, the spinal origin of preganglionic parasympathetic bladder and somatic external urethral sphincter motoneurons is not known. In the male guinea pig using wheat germ agglutinin-conjugated horseradish peroxidase and dextran Alexa Fluor 488/568 tracers, preganglionic parasympathetic bladder motoneurons were observed in the ventrolateral part of the intermediolateral cell group of the first sacral segment. The external urethral sphincter motoneurons were found to be located in the ventral horn of the first sacral segment, in a cell group corresponding with the nucleus of Onuf in cat and human. PMID:15147780

Kuipers, Rutger; Izhar, Zofiet; Gerrits, Peter O; Miner, Wesley; Holstege, Gert

2004-05-13

109

An electromyographic study of the normal function of the external anal sphincter and pelvic diaphragm  

Microsoft Academic Search

Summary  The electrical activity of the external anal sphincter and puborectalis muscle of normal subjects has been investigated using\\u000a concentric needle electrodes.\\u000a \\u000a The activity in these muscles at rest, during voluntary and involuntary contractions and during defecation is described.\\u000a \\u000a \\u000a The findings show a delicate adjustment of activity to changing needs.\\u000a \\u000a \\u000a Variations in sphincter tone result from changes in the firing rate

D. Taverner; F. G. Smiddy

1959-01-01

110

Physiological attributes of the pyloric caeca and anterior intestine of green sunfish ( Lepomis cyanellus) potentially influencing microhabitat specificity of Leptorhynchoides thecatus (Acanthocephala)  

Microsoft Academic Search

Pyloric caeca are present in some species of fish and serve as a habitat for many helminth parasites. Physiological and biochemical attributes of luminal contents of the caeca and proximal intestine of green sunfish, Lepomis cyanellus, were compared to determine factors that could account for localization of Leptorhynchoides thecatus (Acanthocephala) in caeca after initial establishment in caeca and anterior portion

Dennis J. Richardson; Brent B. Nickol

1999-01-01

111

Identification of Paneth cells in pyloric glands associated with gastric and intestinal mixed-type intestinal metaplasia of the human stomach  

Microsoft Academic Search

We have proposed that intestinal metaplasia (IM) of the human stomach be divided into two types on the basis of cell differentiation status: a gastric and intestinal (GI) mixed type and a solely intestinal (I) type. In the GI mixed type, gastric (foveolar epithelial and pyloric gland cells) and intestinal (goblet, intestinal absorptive, and Paneth cells) phenotype cells coexist in

Ken-ichi Inada; Harunari Tanaka; Hayao Nakanishi; Tetsuya Tsukamoto; Yuzuru Ikehara; Keiko Tatematsu; Shigeo Nakamura; Edith Martin Porter; Masae Tatematsu

2001-01-01

112

The use of conventional electromyography to assess external sphincter neuropathy in man  

Microsoft Academic Search

Conventional electromyography was used to measure motor unit potential duration in the external anal sphincter in normal subjects and patients with idiopathic faecal incontinence. The results revealed a direct correlation between age and mean motor unit potential duration in control subjects, but no differences between age-matched male and female subjects. Patients with faecal incontinence exhibited prolongation of mean motor unit

D C Bartolo; J A Jarratt; N W Read

1983-01-01

113

Muscle-Derived Cells for Treatment of Iatrogenic Sphincter Damage and Urinary Incontinence in Men  

PubMed Central

Introduction. Aim of this study was to assess the safety and efficacy of injection of autologous muscle-derived cells into the urinary sphincter for treatment of postprostatectomy urinary incontinence in men and to characterize the injected cells prior to transplantation. Methods. 222 male patients with stress urinary incontinence and sphincter damage after uroloical procedures were treated with transurethral injection of autologous muscle-derived cells. The transplanted cells were investigated after cultivation and prior to application by immunocytochemistry using different markers of myogenic differentiation. Feasibility and functionality assessment was achieved with a follow-up of at least 12 months. Results. Follow-up was at least 12 months. Of the 222 treated patients, 120 responded to therapy of whom 26 patients (12%) were continent, and 94 patients (42%) showed improvement. In 102 (46%) patients, the therapy was ineffective. Clinical improvement was observed on average 4.7 months after transplantation and continued in all improved patients. The cells injected into the sphincter were at least ~50% of myogenic origin and representative for early stages of muscle cell differentiation. Conclusions. Transurethral injection of muscle-derived cells into the damaged urethral sphincter of male patients is a safe procedure. Transplanted cells represent different phases of myogenic differentiation. PMID:22919359

Gerullis, H.; Eimer, C.; Georgas, E.; Homburger, M.; El-Baz, A. G.; Wishahi, M.; Borós, M.; Ecke, T. H.; Otto, T.

2012-01-01

114

Local transdermal delivery of phenylephrine to the anal sphincter muscle using microneedles  

PubMed Central

We propose pretreatment using microneedles to increase perianal skin permeability for locally targeted delivery of phenylephrine (PE), a drug that increases resting anal sphincter pressure to treat fecal incontinence. Microneedle patches were fabricated by micromolding poly-lactic-acid. Pre-treatment of human cadaver skin with microneedles increased PE delivery across the skin by up to 10-fold in vitro. In vivo delivery was assessed in rats receiving treatment with or without use of microneedles and with or without PE. Resting anal sphincter pressure was then measured over time using water-perfused anorectal manometry. For rats pretreated with microneedles, topical application of 30% PE gel rapidly increased the mean resting anal sphincter pressure from 7 ± 2 cm H2O to a peak value of 43 ± 17 cm H2O after 1 h, which was significantly greater than rats receiving PE gel without microneedle pretreatment. Additional safety studies showed that topically applied green fluorescent protein–expressing E. coli penetrated skin pierced with 23- and 26-gauge hypodermic needles, but E. coli was not detected in skin pretreated with microneedles, which suggests that microneedle-treated skin may not be especially susceptible to infection. In conclusion, this study demonstrates local transdermal delivery of PE to the anal sphincter muscle using microneedles, which may provide a novel treatment for fecal incontinence. PMID:21586307

Baek, Changyoon; Han, MeeRee; Min, Junghong; Prausnitz, Mark R.; Park, Jung-Hwan; Park, Jungho

2014-01-01

115

Experience with a new prosthetic anal sphincter in three coloproctological centres  

PubMed Central

Background Fecal incontinence is a common and severely disabling disorder. For patients with severe fecal incontinence, surgery may prove to be the only adequate treatment option. Methods This study reports on 43 patients that were treated with a prosthetic sphincter system between 2005 and 2009 in three coloproctological centres. Main Outcome Measures: complications, anal pressures before and after surgery, fecal continence score. Results The new artificial sphincter system significantly improves continence but leads to some complications in clinical practice. After implantation of the device, continence improved significantly (Keller & Jostarndt continence score 2.6 to 14.3 (P?sphincter squeeze pressure (32.2 mmHg versus 85.9 mm Hg, P?sphincter, improves severe anal incontinence, but it must be regarded as a last treatment option to avoid a stoma. PMID:24502440

2013-01-01

116

Transvaginal Versus Anal Endosonography for Detecting Damage to the Anal Sphincter  

Microsoft Academic Search

OBJECTIVE. We undertook this study to establish the accuracy of transvaginal endosonography for detecting damage to the anal sphincter. SUBJECTS AND METHODS. Anal endosonography was performed in 47 parous patients and one nulliparous patient using a sonographic scanner, an 1850 endoprobe, and a 10-MHz trans- ducer protected by a water-filled hard plastic cone. This procedure was followed by transvaginal sonography

Andrea Frudinger; Clive I. Bartram; Michael A. Kamm

117

[Is sphincter-plasty for treatment of fecal incontinence in patients older than 60 justified?].  

PubMed

Overlapping sphincteroplasty is the method of choice for isolated anterior sphincter defects. Patients over 60 years of age can undergo this operation with similar good results as in younger patients. However, preoperative physiologic assessment of the pelvic floor is necessary for a good postoperative outcome. PMID:9101903

Pfeifer, J; Rabl, H; Uranüs, S; Wexner, S D

1996-01-01

118

A comparison between electromyography and anal endosonography in mapping external anal sphincter defects  

Microsoft Academic Search

Mapping of the external anal sphincter by anal endosonography was compared with the electromyographic findings in 15 patients with fecal incontinence after perineal trauma. Both examinations showed no defect in three patients. In the 12 patients with muscle defects, there was agreement on the quadrant involved in all patients. In seven patients, there was total agreement in the hours of

Penelope J. Law; M. A. Kamm; C. I. Bartram

1990-01-01

119

Current Evaluation of Upper Oesophageal Sphincter Opening in Dysphagia Practice: An International SLT Survey  

ERIC Educational Resources Information Center

Background: The assessment of adequate upper oesophageal sphincter (UOS) opening during swallowing is an integral component of dysphagia evaluation. Aims: To ascertain speech and language therapists' (SLTs) satisfaction with current methods for assessing UOS function in people with dysphagia and to identify challenges encountered by SLTs with UOS…

Regan, Julie; Walshe, Margaret; McMahon, Barry P.

2012-01-01

120

Initiation of Voiding in Humans: The Nature and Temporal Relationship of Urethral Sphincter Responses  

Microsoft Academic Search

PurposeThe nature and sequence of events during the initiation phase of human micturition are unclear. Disagreement concerning the urethra sphincter response to detrusor contraction may stem from the functional extension of periurethral striated muscle to the bladder neck in many but not all individuals, and the methods used during conventional cystometry, in which individuals are asked to forestall urination for

Subbarao V. Yalla; Neil M. Resnick

1997-01-01

121

An Audit of Clinician Compliance with Best Practice Recommendations to Repair Severe Obstetric Anal Sphincter Injuries  

PubMed Central

Context: Obstetric anal sphincter injuries occur uncommonly in Caribbean practice but are accompanied by substantial morbidity. Objective: To evaluate clinicians’ compliance with management guidelines at a national referral hospital in Jamaica. Design: Retrospective review of the records of all consecutive obstetric patients with anal sphincter injuries between November 1, 2007, and December 30, 2012. Main Outcome Measures: The primary end point was the completion of each of 8 tasks from existing management guidelines: 1) interdisciplinary consultation, 2) perineal examination with the patient under anesthesia, 3) injury repair in the operating room, 4) prophylactic antibiotics at induction, 5) repair by an experienced clinician, 6) repair method appropriate for injury grade, 7) slowly absorbable suture chosen for sphincter repair, and 8) rapidly absorbable suture for mucosal repair. We quantified clinician compliance with the guidelines by assigning a score of 1 for each task completed and 0 for an incomplete task. Individual task scores were summed. Clinicians were considered compliant when their overall score was above 6. Results: Twenty-six women (mean age = 27 years; standard deviation = 5.78 years) had obstetric anal sphincter injuries. Nine cases (34.6%) earned clinician compliance scores above 6, and 17 (65.4%) had scores of 6 or below. Experienced clinicians repaired all the injuries in this study—the only task for which compliance was 100%. Conclusion: Despite attempts at improving therapeutic outcomes by creating tailored guidelines for repair of obstetric anal sphincter injuries, there is a serious barrier to success because 65% of senior clinicians were noncompliant. PMID:25102516

Cawich, Shamir O; Kulkarni, Santosh; Ramdass, Michael; Hassranah, Dale; Bambury, Ian; Christie, Loxley R; Naraynsingh, Vijay

2014-01-01

122

Postpartum anal sphincter lacerations in a population with minimal exposure to episiotomy and operative vaginal delivery  

Microsoft Academic Search

This case–control study was designed to identify risk factors for anal sphincter lacerations (ASL) in a multicultural population\\u000a where episiotomies and operative vaginal deliveries are rarely performed. Cases were subjects with ASL delivered between July\\u000a 1997 and June 2003. Two controls were selected for each case matched for gestational age. Independent variables collected\\u000a included age, race\\/ethnicity, parity, tobacco use, medical

Cindi Lewis; Alana M. Williams; Rebecca G. Rogers

2008-01-01

123

Sphincter-Preserving Therapy for Treating a Chronic Anal Fissure: Long-term Outcomes  

PubMed Central

Purpose To estimate the risk of recurrent fissure in ano after sphincter preserving treatments. Methods A retrospective case note review, combined with a telephone survey was conducted for all patients treated for a chronic anal fissure between 1998 and 2008. Results Six hundred and twelve patients (303 women: mean age, 39 years; range, 16-86 years) were treated for chronic anal fissure between 1998 and 2008. Topical diltiazem 2% was initially prescribed for 8 weeks. The fissure did not heal in 141 patients. These patients (61 women: mean age, 30 years; range, 15-86 years) were treated with 100 IU botulinum A toxin (Botox) injection combined with a fissurectomy under general anaesthesia. Thirty eight patients suffered a recurrence of their fissure within two years. Thirty-four healed with further medical or sphincter conserving surgical therapy while four required a lateral internal sphincterotomy. Conclusion The vast majority of patients with chronic anal fissure can be treated with sphincter conserving treatments. This may require several interventions before healing can be achieved. Assessment for recurrence after 'conservative' treatments requires a minimum of two-year follow-up. PMID:24999464

Farouk, Ridzuan

2014-01-01

124

Olfactory dysfunction in dementia.  

PubMed

The natural aging process brings about some inevitable consequences, such as olfactory dysfunction, which is also frequently linked to numerous neurodegenerative disorders. Many age-related dementia, such as Alzheimer's disease, Vascular dementia, Parkinson's disease, and Frontotemporal Dementia often display olfactory dysfunction. Despite the overwhelming evidence of above mentioned facts, the symptomatic relevance and potential clinical and pre-clinical value of olfactory dysfunction remains overlooked by many clinicians and public alike. Olfactory dysfunction has strong practical implications on daily activities and, although not as prominent as in other mammals, olfaction is still an evolutionarily relevant sense involved in human survival (e.g., smelling gas; bad food). In this work, we provide a brief review of current research related to the olfactory dysfunction profiles in different types of dementia. Additionally, we present a compilation of accessible, easy to use olfaction assessment tools; and highlight future directions in terms of improving clinical diagnosis in patient care and research. PMID:25405189

Alves, Jorge; Petrosyan, Agavni; Magalhães, Rosana

2014-11-16

125

Palliation of Pyloric Stenosis Caused by Gastric Cancer Using an Endoscopically Placed Covered Ultraflex Stent: Covered Stent Inside an Occluded Uncovered Stent  

Microsoft Academic Search

A 71-year-old man developed pyloric stenosis caused by gastric cancer. Vomiting and nausea resolved after the insertion of an uncovered Ultraflex stent (length 10 cm, inner diameter 18u23 mm) through a 7-cm-long stenosis, and the patient was able to eat a soft diet. After 6 weeks, stent occlusion occurred due to tumor ingrowth and accumulation of food residue. Endoscopic observation

Toshifumi Nakamura; Mutsuo Kitagawa; Yasunori Takehira; Masami Yamada; Yoshiro Nishiwaki; Hirotoshi Nakamura

2000-01-01

126

Palliation of Pyloric Stenosis Caused by Gastric Cancer Using an Endoscopically Placed Covered Ultraflex Stent: Covered Stent Inside an Occluded Uncovered Stent  

Microsoft Academic Search

A 71-year-old man developed pyloric stenosis caused by gastric cancer. Vomiting and nausea resolved after the insertion of\\u000a an uncovered Ultraflex stent (length 10 cm, inner diameter 1823 mm) through a 7-cm-long stenosis, and the patient was able\\u000a to eat a soft diet. After 6 weeks, stent occlusion occurred due to tumor ingrowth and accumulation of food residue. Endoscopic\\u000a observation

Toshifumi Nakamura; Mutsuo Kitagawa; Yasunori Takehira; Masami Yamada; Yoshiro Nishiwaki; Hirotoshi Nakamura

2000-01-01

127

Relationship of bladder dysfunction with upper urinary tract deterioration in cerebral palsy.  

PubMed

Although lower urinary tract dysfunction (LUTD) in patients with cerebral palsy (CP) has been previously documented by clinical observations and urodynamic tests, its correlation with upper urinary tract deterioration (UUTD) has not been demonstrated. This paper documents symptoms and urodynamic findings of LUTD and their relationship with UUTD in 33 children with CP. By sonography, 4 of these children were found to have UUTD. Age was found to correlate with UUTD, but gender difference and mental or motor functions did not. When comparing urinary symptoms with UUTD, incontinence (n = 31) did not correlate, but on the other hand symptoms of detrusor sphincter dyssynergia (interrupted voiding, urinary retention, hesitancy; n = 5) and culture proven febrile urinary tract infections (n = 4) did. Abnormal urodynamics findings were not diagnostic. We conclude that, apart from incontinence, dysfunctional voiding symptoms and febrile urinary tract infections are valuable indicators of UUTD. PMID:22921013

Gündo?du, Gökhan; Kömür, Mustafa; Avlan, Dinçer; Sar?, Ferda Bacaks?zlar; Deliba?, Ali; Ta?delen, Bahar; Nayc?, Ali; Okuyaz, Cetin

2013-10-01

128

Bladder outlet physiology in the context of lower urinary tract dysfunction.  

PubMed

Physiological function of the bladder outlet is complex and symptomatic consequences can result from outlet dysfunction. Within the outlet, smooth, and skeletal muscles constitute the contractile apparatus, but additional cell types include interstitial cells and neuroendocrine cells, and various transmitters are present in the innervation, raising the possibility of unrecognized functional subtleties. Key outlet functions are; maintained closure for urine storage, increased closure (guarding) during exertion, sustained opening for voiding, transient opening for territorial marking in animals and orthograde male ejaculation. These are co-ordinated by several spinal and higher CNS centers, with overlap of the somatic, sympathetic and parasympathetic nervous systems. During voiding, urethral afferents may be important in maintaining detrusor contraction until completion of bladder emptying. Some of the bladder outlet afferents may be shared with the anal sphincter. Dysfunction of the outlet leads to conditions such as retrograde ejaculation, Fowler's syndrome, and detrusor sphincter dyssynergia. Urethral relaxation during urine storage may lead to urinary urgency, which may be misleadingly labeled as overactive bladder. Research priorities are numerous, including; peripheral cellular integrative physiology, interactions with other pelvic organs, interconnectivity of the CNS centers at all levels of the neuraxis, and standardized animal models of outlet functions such as reflex-driven voiding. PMID:21661018

Sadananda, Prajni; Vahabi, Bahareh; Drake, Marcus J

2011-06-01

129

Temporomandibular Joint Dysfunction  

MedlinePLUS

The temporomandibular joint (TMJ) connects your jaw to the side of your head. When it works well, it enables you to ... For people with TMJ dysfunction, problems with the joint and muscles around it may cause Pain that ...

130

Pelvic Floor Dysfunction  

MedlinePLUS

... Cancer Hemorrhoids Hemorrhoids: Expanded Version Irritable Bowel Syndrome Ostomy Pelvic Floor Dysfunction Pilonidal Disease Polyps of the ... on the surface of the skin around the opening to the rectum (anus) and on the abdominal ...

131

The experience of artificial urinary sphincter implantation by a single surgeon in 15 years.  

PubMed

Artificial urinary sphincter (AUS) is the gold standard treatment for urinary incontinence owing to sphincter incompetence. We reviewed our experience in AUS implantation. From 1995 to 2009, 19 patients underwent 25 AUS implantations performed by a single surgeon. The cause of incontinence was sphincter incompetence, which was secondary to prostate surgery, neurogenic bladder, radiation, and post-traumatic urethral lesion. Twenty-three prostheses were placed in the bulbar urethra for male patients: 11 AUS cuffs were placed through the perineal approach and 12 through the penoscrotal approach. Two procedures were applied over the bladder neck for the female patients. Through a retrospective review of charts, continence and complications were analyzed. The mean follow-up time was 50.0 ± 42.9 months (range: 2-146 months). There were 16 successful surgeries (64%), and these patients were free from the need for a pad. In eight surgeries (32%), the devices were removed due to infection, while one implantation (4%) was unsuccessful due to perforation into the bulbar urethra. There was a statistically significant difference (p = 0.024) in failure rates between patients who received radiotherapy (100%) and other patients (22.7%). There was no statistically significant difference in dry and revision rates (p > 0.05) between the perineal and penoscrotal approach. Accordingly, over half of the patients with total incontinence benefitted from AUS implantation. In consideration of the high failure rate for patients receiving radiotherapy, caution should be exercised in the use of implantation. Secondary implantation has a satisfactory success rate in selected patients. The same success rate was noted for both perineal and penoscrotal approaches. PMID:23465419

Shen, Yuan-Chi; Chiang, Po-Hui

2013-03-01

132

Delayed anastomotic leakage following sphincter-preserving surgery for rectal cancer  

Microsoft Academic Search

Purpose  The aim of the present study was to investigate the characteristics of patients who developed delayed anastomotic leakage\\u000a (DAL) following sphincter-preserving surgery for rectal cancer. We evaluated the following factors: (1) the incidence of DAL,\\u000a (2) the clinical features of patients who developed DAL, (3) the risk factors for DAL, and (4) treatment outcomes.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We reviewed the case histories of

Ui Sup Shin; Chan Wook Kim; Chang Sik Yu; Jin Cheon Kim

2010-01-01

133

[Preeclampsia and tubular dysfunction].  

PubMed

Renal involvement associated with preeclampsia is well investigated, especially from the aspect of glomerular lesion and coagulation. On the other hand, only a few studies on tubular dysfunction during normal pregnancy and preeclampsia have been reported. The first study was carried out to clarify and estimate the chronological changes in tubular function. Pregnant women without obvious tubular dysfunction and toxemia (group A) were investigated using serum Cl, Na minus Cl (Na-Cl index), uric acid and urinary beta 2-microglobulin (u-beta-MG) at the 10th, 20th, 30th and 36th weeks of gestation. The second study was carried out to determine the significance of tubular dysfunction accompanied by preeclampsia. Patients with severe preeclampsia (group B) and normal pregnancy (group C) were examined by the same index of tubular dysfunction. The diagnosis of severe preeclampsia was confirmed with hypertension (over 170/110 mmHg), proteinuria (beyond 3 g/day) and severe edema. The following results were obtained: Urinary beta-MG and serum Cl increased during the third trimester in group A, but the Na-Cl index decreased. The serum uric acid concentration increased during the third trimester in group A. Tubular dysfunction was evident during the third trimester in normal pregnancy. Every index of tubular dysfunction including u-beta-MG, serum Cl, Na-Cl index and uric acid in group B was significantly higher than in group C. In group B, 4 fetuses died and 7 out of 15 cases required Cesarean sections. The critical line of tubular dysfunction for fetal prognosis was Cl 110 mEq/l, Na-Cl index 28 mEq/l, uric acid 6.0 mg/dl and u-beta-MG 1,000 micrograms/l.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3546534

Yoshida, A; Morozumi, K; Shinmura, I; Yagami, Y

1987-01-01

134

Mean Absorbed Dose to the Anal-Sphincter Region and Fecal Leakage among Irradiated Prostate Cancer Survivors  

SciTech Connect

Purpose: To supplement previous findings that the absorbed dose of ionizing radiation to the anal sphincter or lower rectum affects the occurrence of fecal leakage among irradiated prostate-cancer survivors. We also wanted to determine whether anatomically defining the anal-sphincter region as the organ at risk could increase the degree of evidence underlying clinical guidelines for restriction doses to eliminate this excess risk. Methods and Materials: We identified 985 men irradiated for prostate cancer between 1993 and 2006. In 2008, we assessed long-term gastrointestinal symptoms among these men using a study-specific questionnaire. We restrict the analysis to the 414 men who had been treated with external beam radiation therapy only (no brachytherapy) to a total dose of 70 Gy in 2-Gy daily fractions to the prostate or postoperative prostatic region. On reconstructed original radiation therapy dose plans, we delineated the anal-sphincter region as an organ at risk. Results: We found that the prevalence of long-term fecal leakage at least once per month was strongly correlated with the mean dose to the anal-sphincter region. Examining different dose intervals, we found a large increase at 40 Gy; {>=}40 Gy compared with <40 Gy gave a prevalence ratio of 3.8 (95% confidence interval 1.6-8.6). Conclusions: This long-term study shows that mean absorbed dose to the anal-sphincter region is associated with the occurrence of long-term fecal leakage among irradiated prostate-cancer survivors; delineating the anal-sphincter region separately from the rectum and applying a restriction of a mean dose <40 Gy will, according to our data, reduce the risk considerably.

Alsadius, David, E-mail: david.alsadius@oncology.gu.se [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden)] [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden); Hedelin, Maria [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden) [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm (Sweden); Lundstedt, Dan [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden)] [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden); Pettersson, Niclas [Department of Radiophysics, Sahlgrenska Academy at University of Gothenburg (Sweden)] [Department of Radiophysics, Sahlgrenska Academy at University of Gothenburg (Sweden); Wilderaeng, Ulrica [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden)] [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden); Steineck, Gunnar [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden) [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm (Sweden)

2012-10-01

135

Olfactory dysfunction in dementia  

PubMed Central

The natural aging process brings about some inevitable consequences, such as olfactory dysfunction, which is also frequently linked to numerous neurodegenerative disorders. Many age-related dementia, such as Alzheimer’s disease, Vascular dementia, Parkinson’s disease, and Frontotemporal Dementia often display olfactory dysfunction. Despite the overwhelming evidence of above mentioned facts, the symptomatic relevance and potential clinical and pre-clinical value of olfactory dysfunction remains overlooked by many clinicians and public alike. Olfactory dysfunction has strong practical implications on daily activities and, although not as prominent as in other mammals, olfaction is still an evolutionarily relevant sense involved in human survival (e.g., smelling gas; bad food). In this work, we provide a brief review of current research related to the olfactory dysfunction profiles in different types of dementia. Additionally, we present a compilation of accessible, easy to use olfaction assessment tools; and highlight future directions in terms of improving clinical diagnosis in patient care and research. PMID:25405189

Alves, Jorge; Petrosyan, Agavni; Magalhães, Rosana

2014-01-01

136

Lack of effect of a 5-HT3 antagonist, pancopride, on lower oesophageal sphincter pressure in volunteers.  

PubMed Central

Effects of pancopride (5 and 10 mg, intravenously), on lower oesophageal sphincter pressure (LOESP), were assessed in healthy volunteers by means of oesophageal manometry. After pancopride 10 mg, the LOESP was higher than placebo and 5 mg pancopride but there were no differences among the three treatments (P = 0.42). The areas under the curve were similar without differences, neither with absolute measurements (P = 0.53) nor after a baseline correction (P = 0.16). In conclusion, pancopride has no clinically relevant effect on lower oesophageal sphincter pressure. PMID:8554943

Grande, L; Lacima, G; Pérez, A; Zayas, J M

1995-01-01

137

Metal-sensitive and thermostable trypsin from the crevalle jack (Caranx hippos) pyloric caeca: purification and characterization  

PubMed Central

Background Over the past decades, the economic development and world population growth has led to increased for food demand. Increasing the fish production is considered one of the alternatives to meet the increased food demand, but the processing of fish leads to by-products such as skin, bones and viscera, a source of environmental contamination. Fish viscera have been reported as an important source of digestive proteases with interesting characteristics for biotechnological processes. Thus, the aim of this study was to purify and to characterize a trypsin from the processing by-products of crevalle jack (Caranx hippos) fish. Results A 27.5 kDa trypsin with N-terminal amino acid sequence IVGGFECTPHVFAYQ was easily purified from the pyloric caeca of the crevalle jack. Its physicochemical and kinetic properties were evaluated using N-?-benzoyl-DL-arginine-p-nitroanilide (BApNA) as substrate. In addition, the effects of various metal ions and specific protease inhibitors on trypsin activity were determined. Optimum pH and temperature were 8.0 and 50°C, respectively. After incubation at 50°C for 30 min the enzyme lost only 20% of its activity. K m , k cat, and k cat /K m values using BApNA as substrate were 0.689 mM, 6.9 s-1, and 10 s-1 mM-1, respectively. High inhibition of trypsin activity was observed after incubation with Cd2+, Al3+, Zn2+, Cu2+, Pb2+, and Hg2+ at 1 mM, revealing high sensitivity of the enzyme to metal ions. Conclusions Extraction of a thermostable trypsin from by-products of the fishery industry confirms the potential of these materials as an alternative source of these biomolecules. Furthermore, the results suggest that this trypsin-like enzyme presents interesting biotechnological properties for industrial applications. PMID:24112762

2013-01-01

138

Primary anorectal malignant melanoma treated with neoadjuvant chemoradiotherapy and sphincter-sparing surgery: A case report  

PubMed Central

Primary anorectal (PA) malignant melanoma (MM) is a rare disease associated with a high mortality rate. The most appropriate treatment strategy for PAMM remains controversial. A 55-year-old female patient, who was misdiagnosed with locally advanced rectal carcinoma, was treated with preoperative radiotherapy and concurrent oral capecitabine. During the therapy, grade 1 leukopenia occurred, however, there was no interruption to treatment. Following chemoradiotherapy, a computer tomography scan identified that the tumor had shrunk significantly and the original enlarged lymph nodes had disappeared. Eight weeks after completion of chemoradiotherapy, sphincter-sparing surgery was performed on the patient and based on the postoperative pathological result, MM was diagnosed. At the time of writing, the patient has survived disease-free for 15 months and at the most recent follow-up examination the Karnofsky Performance Scale score was 100. The therapeutic regimen of neoadjuvant concurrent chemoradiotherapy together with sphincter-sparing surgery is considered to be an optimal choice for patients with PAMM. However, further studies are required to evaluate the efficacy and clinical utility of this therapeutic regimen. PMID:24765186

SU, MENG; ZHU, LUCHENG; LUO, WENHUA; WEI, HANGPING; ZOU, CHANGLIN

2014-01-01

139

Electromagnetic assessment of embedded micro antenna for a novel sphincter in the human body.  

PubMed

This paper presents a wireless, miniaturized, bi-directional telemetric artificial anal sphincter system that can be used for controlling patients' anal incontinence. The artificial anal sphincter system is mainly composed of an executive mechanism, a wireless power supply system and a wireless communication system. The wireless communication system consists of an internal RF transceiver, an internal RF antenna, a data transmission pathway, an external RF antenna and an external RF control transceiver. A micro NMHA (Normal Mode Helical Antenna) has been used for the transceiver of the internal wireless communication system and a quarter wave-length whip antenna of 7.75 cm has been used for the external wireless communication system. The RF carrier frequency of wireless communication is located in a license-free 433.1 MHz ISM (Industry, Science, and Medical) band. The radiation characteristics and SAR (Specific Absorption Rate) are evaluated using the finite difference time-domain method and 3D human body model. Results show that the SAR values of the antenna satisfy the ICNIRP (International Commission on Nonionizing Radiation Protection) limitations. PMID:23706019

Zan, Peng; Liu, Jinding; Ai, Yutao; Jiang, Enyu

2013-05-01

140

Automatic detection of motor unit innervation zones of the external anal sphincter by multichannel surface EMG.  

PubMed

A method to detect automatically the location of innervation zones (IZs) from 16-channel surface EMG (sEMG) recordings from the external anal sphincter (EAS) muscle is presented in order to guide episiotomy during child delivery. The new algorithm (2DCorr) is applied to individual motor unit action potential (MUAP) templates and is based on bidimensional cross correlation between the interpolated image of each MUAP template and two images obtained by flipping upside-down (around a horizontal axis) and left-right (around a vertical axis) the original one. The method was tested on 640 simulated MUAP templates of the sphincter muscle and compared with previously developed algorithms (Radon Transform, RT; Template Match, TM). Experimental signals were detected from the EAS of 150 subjects using an intra-anal probe with 16 equally spaced circumferential electrodes. The results of the three algorithms were compared with the actual IZ location (simulated signal) and with IZ location provided by visual analysis (VA) (experimental signals). For simulated signals, the inter quartile error range (IQR) between the estimated and the actual locations of the IZ was 0.20, 0.23, 0.42, and 2.32 interelectrode distances (IED) for the VA, 2DCorr, RT and TM methods respectively. PMID:24948528

Ullah, Khalil; Cescon, Corrado; Afsharipour, Babak; Merletti, Roberto

2014-12-01

141

The cone dysfunction syndromes  

PubMed Central

The cone dystrophies comprise a heterogeneous group of disorders characterised by visual loss, abnormalities of colour vision, central scotomata, and a variable degree of nystagmus and photophobia. They may be stationary or progressive. The stationary cone dystrophies are better described as cone dysfunction syndromes since a dystrophy often describes a progressive process. These different syndromes encompass a wide range of clinical and psychophysical findings. The aim is to review current knowledge relating to the cone dysfunction syndromes, with discussion of the various phenotypes, the currently mapped genes, and genotype-phenotype relations. The cone dysfunction syndromes that will be discussed are complete and incomplete achromatopsia, oligocone trichromacy, cone monochromatism, blue cone monochromatism, and Bornholm eye disease. Disorders with a progressive cone dystrophy phenotype will not be discussed. PMID:14736794

Michaelides, M; Hunt, D M; Moore, A T

2004-01-01

142

Sexual dysfunctions in depression.  

PubMed

The incidence of sexual dysfunctions in a group of 51 drug-free depressed patients and in age- and sex-matched controls was studied. Three groups of sexual dysfunction were assessed: alterations of libido, genital symptoms, and menstrual irregularities. The Beck Rating Scale for Depression, the Eysenck Personality Inventory (EPI), and the State-Trait Anxiety Inventory were completed on each participant. Depressed patients obtained significantly higher scores on anxiety, depression, and alterations of libido than controls. Rating scale scores for anxiety and depression were strongly intercorrelated, making the separation of depression-related symptoms from anxiety difficult. In males, the genital symptoms correlated inversely with the L (lie) score of the Eysenck Personality Inventory. There were no interrelationships between the three groups of sexual dysfunction. PMID:7149967

Mathew, R J; Weinman, M L

1982-08-01

143

Immune dysfunction in cirrhosis.  

PubMed

Innate and adaptive immune dysfunction, also referred to as cirrhosis-associated immune dysfunction syndrome, is a major component of cirrhosis, and plays a pivotal role in the pathogenesis of both the acute and chronic worsening of liver function. During the evolution of the disease, acute decompensation events associated with organ failure(s), so-called acute-on chronic liver failure, and chronic decompensation with progression of liver fibrosis and also development of disease specific complications, comprise distinct clinical entities with different immunopathology mechanisms. Enhanced bacterial translocation associated with systemic endotoxemia and increased occurrence of systemic bacterial infections have substantial impacts on both clinical situations. Acute and chronic exposure to bacteria and/or their products, however, can result in variable clinical consequences. The immune status of patients is not constant during the illness; consequently, alterations of the balance between pro- and anti-inflammatory processes result in very different dynamic courses. In this review we give a detailed overview of acquired immune dysfunction and its consequences for cirrhosis. We demonstrate the substantial influence of inherited innate immune dysfunction on acute and chronic inflammatory processes in cirrhosis caused by the pre-existing acquired immune dysfunction with limited compensatory mechanisms. Moreover, we highlight the current facts and future perspectives of how the assessment of immune dysfunction can assist clinicians in everyday practical decision-making when establishing treatment and care strategies for the patients with end-stage liver disease. Early and efficient recognition of inappropriate performance of the immune system is essential for overcoming complications, delaying progression and reducing mortality. PMID:24627592

Sipeki, Nora; Antal-Szalmas, Peter; Lakatos, Peter L; Papp, Maria

2014-03-14

144

Dysfunction Travel-associated  

E-print Network

Multiorgan Dysfunction Caused by Travel-associated African Trypanosomiasis Lucy E. Cottle, Joanna RMED-mail in persons who had traveled to this region. Trypanosomiasis remains rare in travelers but should be considered in febrile patients who have returned from trypanosomiasis-endemic areas of Africa. We describe

Steve Kemp

145

Perceptual-Motor Dysfunction.  

ERIC Educational Resources Information Center

Discussed are theoretical and treatment aspects of perceptual motor dysfunction and rehabilitation in 4- to 12-year-old academically failing children involved in a 3-year investigation at the University of Kansas. The program is said to stress increasing the amount of stimulation received by sensory receptors of the vestibular, reflex, and haptic…

Pyfer, Jean L.

146

Mitochondrial Dysfunction in Cancer  

PubMed Central

A mechanistic understanding of how mitochondrial dysfunction contributes to cell growth and tumorigenesis is emerging beyond Warburg as an area of research that is under-explored in terms of its significance for clinical management of cancer. Work discussed in this review focuses less on the Warburg effect and more on mitochondria and how dysfunctional mitochondria modulate cell cycle, gene expression, metabolism, cell viability, and other established aspects of cell growth and stress responses. There is increasing evidence that key oncogenes and tumor suppressors modulate mitochondrial dynamics through important signaling pathways and that mitochondrial mass and function vary between tumors and individuals but the significance of these events for cancer are not fully appreciated. We explore the interplay between key molecules involved in mitochondrial fission and fusion and in apoptosis, as well as in mitophagy, biogenesis, and spatial dynamics of mitochondria and consider how these distinct mechanisms are coordinated in response to physiological stresses such as hypoxia and nutrient deprivation. Importantly, we examine how deregulation of these processes in cancer has knock on effects for cell proliferation and growth. We define major forms of mitochondrial dysfunction and address the extent to which the functional consequences of such dysfunction can be determined and exploited for cancer diagnosis and treatment. PMID:24350057

Boland, Michelle L.; Chourasia, Aparajita H.; Macleod, Kay F.

2013-01-01

147

Early effect of external beam radiation therapy on the anal sphincter: A study using anal manometry and transrectal ultrasound  

SciTech Connect

The early of pelvic irradiation on the anal sphincter has not been previously investigated. This study prospectively evaluated the acute effect of preoperative radiation on anal function. Twenty patients with rectal carcinoma received 4,500 cGy of preoperative external beam radiation. The field of radiation included the sphincter in 10 patients and was delivered above the anorectal ring in 10 patients. Anal manometry and transrectal ultrasound were performed before and four weeks after radiotherapy. No significant difference in mean maximal squeeze or resting pressure was found after radiation therapy. An increase in mean minimal sensory threshold was significant. Histologic examination revealed minimal radiation changes at the distal margin in 8 of 10 patients who underwent low anterior resection and in 1 of 3 patients who underwent abdominoperineal resection. The authors conclude that preoperative radiation therapy has minimal immediate effect on the anal sphincter and is not a major contributing factor to postoperative incontinence in patients after sphincter-saving operations for rectal cancer.

Birnbaum, E.H.; Dreznik, Z.; Myerson, R.J.; Lacey, D.L.; Fry, R.D.; Kodner, I.J.; Fleshman, J.W. (Jewish Hospital of St. Louis, Washington University Medical Center, MO (United States))

1992-08-01

148

Damage to the innervation of the voluntary anal and periurethral sphincter musculature in incontinence: an electrophysiological study  

Microsoft Academic Search

In 40 women with idiopathic (neurogenic) faecal incontinence, 20 of whom also had stress urinary incontinence, single fibre EMG studies showed an increased fibre density in the external anal sphincter muscle. All these patients showed excessive descent of the pelvic floor on straining. The mean terminal motor latencies in the pudendal and perineal nerves, measured by a digitally-directed intrarectal stimulating

S J Snooks; P R Barnes; M Swash

1984-01-01

149

Effect of atropine on the frequency of reflux and transient lower esophageal sphincter relaxation in normal subjects  

Microsoft Academic Search

Background & Aims Low basal lower esophageal sphincter (LES) pressure is believed to be an important mechanism of reflux. The effects of atropine on the frequency and mechanisms of gastroesophageal reflux under the experimental conditions of a low basal LES pressure in 13 normal subjects were studied. Methods LES pressure, esophageal pressures, esophageal pH, and crural diaphragm electromyogram were recorded

Ravinder K. Mittal; Richard Holloway; John Dent

1995-01-01

150

Mitochondrial dysfunction in neurodegenerative diseases  

Microsoft Academic Search

A potential pivotal role for mitochondrial dysfunction in neurodegenerative diseases is gaining increasing acceptance. Mitochondrial dysfunction leads to a number of deleterious consequences including impaired calcium buffering, generation of free radicals, activation of the mitochondrial permeability transition and secondary excitotoxicity. Neurodegenerative diseases of widely disparate genetic etiologies may share mitochondrial dysfunction as a final common pathway. Recent studies using cybrid

M. Flint Beal

1998-01-01

151

Reappraisal of the Immunophenotype of Pancreatic Intraductal Papillary Mucinous Neoplasms (IPMNs)—Gastric Pyloric and Small Intestinal Immunophenotype Expression in Gastric and Intestinal Type IPMNs—  

PubMed Central

Pancreatic intraductal papillary mucinous neoplasms (IPMNs) are mucin-producing neoplasms of the main and/or branch pancreatic ducts. To assess differences between various IPMN subtypes, immunohistochemical markers of gastric surface mucous cells (MUC5AC), gastric gland mucous cells (MUC6 and GlcNAc?1?4Gal??R), gastric pyloric and duodenal epithelial cells (PDX1), intestinal cells (MUC2 and CDX2), small intestinal cells (CPS1) and large intestinal cells (SATB2) were evaluated in 33 surgically treated IPMNs. MUC2 expression classified IPMNs into gastric (n=17), intestinal (n=8) and mixed gastric and intestinal type (collision=7, composite=1). No differences in age or sex were observed among these types. MUC5AC and PDX1 were expressed in all IPMNs. MUC6 expression was higher in gastric and mixed types than in intestinal type. GlcNAc?1?4Gal??R was detected in gastric and mixed type, but not in intestinal type. MUC2 and CDX2 expression were higher in intestinal type than gastric and mixed type. CPS1 expression was higher in intestinal type than gastric type. SATB2 was not observed in any IPMNs. Frequent abrupt transition between the two IPMN types in mixed-type IPMNs was observed. Gastric pyloric and small intestinal differentiation are characteristic of gastric and intestinal type IPMN, respectively, and these two IPMN types may have distinct pathogenesis. PMID:25221363

Kobayashi, Mikiko; Fujinaga, Yasunari; Ota, Hiroyoshi

2014-01-01

152

Prolonged prostaglandin E1 therapy in a neonate with pulmonary atresia and ventricular septal defect and the development of antral foveolar hyperplasia and hypertrophic pyloric stenosis  

PubMed Central

Prostaglandin E1 (alprostadil) is widely used for maintaining the patency of ductus arteriosus in ductus-dependent congenital heart defects in neonates to improve oxygenation. Among more common side effects are fever, rash, apnoea, diarrhoea, jitteriness, and flushing. More severe side effects are brown fat necrosis, cortical hyperostosis, and gastric outlet obstruction, most commonly the result of antral foveolar hyperplasia or hypertrophic pyloric stenosis. We report on an infant with a ductus-dependent congenital heart defect who developed symptoms and sonographic evidence of focal foveolar hyperplasia and hypertrophic pyloric stenosis after prolonged treatment with prostaglandin E1. Gastrointestinal symptoms persisted after corrective cardiac surgery, and pyloromyotomy was required. Study of the case and of available literature showed an association between the total dose of prostaglandin E1 administered and duration of treatment and the development of gastric outlet obstruction. We conclude that if patients are treated with a prostaglandin E1 infusion, careful monitoring for symptoms and signs of gastric outlet obstruction is required. PMID:23521358

Perme, Tina; Mali, Senja; Vidmar, Ivan; Gvardijan?i?, Diana; Blumauer, Robert; Mishaly, David; Grabnar, Iztok; Nemec, Gregor

2013-01-01

153

Prolonged prostaglandin E1 therapy in a neonate with pulmonary atresia and ventricular septal defect and the development of antral foveolar hyperplasia and hypertrophic pyloric stenosis.  

PubMed

Prostaglandin E1 (alprostadil) is widely used for maintaining the patency of ductus arteriosus in ductus-dependent congenital heart defects in neonates to improve oxygenation. Among more common side effects are fever, rash, apnoea, diarrhoea, jitteriness, and flushing. More severe side effects are brown fat necrosis, cortical hyperostosis, and gastric outlet obstruction, most commonly the result of antral foveolar hyperplasia or hypertrophic pyloric stenosis. We report on an infant with a ductus-dependent congenital heart defect who developed symptoms and sonographic evidence of focal foveolar hyperplasia and hypertrophic pyloric stenosis after prolonged treatment with prostaglandin E1. Gastrointestinal symptoms persisted after corrective cardiac surgery, and pyloromyotomy was required. Study of the case and of available literature showed an association between the total dose of prostaglandin E1 administered and duration of treatment and the development of gastric outlet obstruction. We conclude that if patients are treated with a prostaglandin E1 infusion, careful monitoring for symptoms and signs of gastric outlet obstruction is required. PMID:23521358

Perme, Tina; Mali, Senja; Vidmar, Ivan; Gvardijan?i?, Diana; Blumauer, Robert; Mishaly, David; Grabnar, Iztok; Nemec, Gregor; Grosek, Stefan

2013-05-01

154

Use of macrolides in mother and child and risk of infantile hypertrophic pyloric stenosis: nationwide cohort study  

PubMed Central

Objective To assess the association between use of macrolide antibiotics in mothers and infants from pregnancy onset until 120 days after birth and infantile hypertrophic pyloric stenosis (IHPS). Design Nationwide register based cohort study. Setting Denmark, 1996-2011. Participants 999?378 liveborn singletons and linked individual level information on macrolide prescriptions (maternal use during pregnancy, n=30?091; maternal use after birth, n=21?557; use in infants, n=6591), surgery for IHPS, and potential confounders. Main outcome measures Surgery for IHPS by three categories of macrolide use: in mothers during pregnancy, in mothers after birth, and in infants after birth. Results 880 infants developed IHPS (0.9 cases per 1000 births). Compared with infants with no use of macrolides, the adjusted rate ratio for IHPS in infants with use of macrolides during days 0 to 13 after birth was 29.8 (95% confidence interval 16.4 to 54.1) and during days 14 to 120 was 3.24 (1.20 to 8.74); the corresponding absolute risk differences were 24.4 (95% confidence interval 13.0 to 44.1) and 0.65 (0.06 to 2.21) cases per 1000 infants exposed to macrolides, respectively. The rate ratio for maternal use of macrolides for days 0 to 13 after birth was 3.49 (1.92 to 6.34) and for days 14 to 120 was 0.70 (0.26 to 1.90); the corresponding absolute risk differences were 2.15 (0.82 to 4.64) and ?0.11 (?0.26 to 0.31). The rate ratios for maternal use of macrolides during pregnancy were 1.02 (0.65 to 1.59) for weeks 0 to 27 and 1.77 (0.95 to 3.31) for weeks 28 to birth; the corresponding absolute risk differences were 0.01 (?0.31 to 0.50) and 0.67 (?0.06 to 2.02). Conclusions Treatment of young infants with macrolide antibiotics was strongly associated with IHPS and should therefore only be administered if potential treatment benefits outweigh the risk. Maternal use of macrolides during the first two weeks after birth was also associated with an increased risk of IHPS. A possible association was also found with use during late pregnancy. PMID:24618148

2014-01-01

155

Individual motor unit analysis in the diagnosis of disorders of urethral sphincter innervation.  

PubMed Central

A technique is described for recording the electromyographic activity of striated muscle in the urethral sphincter. Using a concentric needle electrode and an oscilloscope with a delay line and trigger, individual motor units were isolated and measured. To validate the method as a means of detecting pathology, the results are presented of analysis of the motor units of a group of patients with disturbances of micturition, known to have either cauda equina lesions or pelvic nerve injury. These results are compared with those from a group of controls. In the control group 93% of the motor units were less than 6 ms in duration and 2.0 mv in amplitude. Of motor units recorded from patients with cauda equina or pelvic nerve injury 59% exceeded the control ranges for amplitude or duration. It is concluded that quantitative analysis of individual motor units may be a helpful technique in the investigation of patients with disorders of micturition. PMID:6736998

Fowler, C J; Kirby, R S; Harrison, M J; Milroy, E J; Turner-Warwick, R

1984-01-01

156

Outcome of repair of obstetric anal sphincter injuries after three years  

PubMed Central

Objective To prospectively assess change in bowel symptoms and quality of life (QoL) approximately 3 years after primary repair of obstetric anal sphincter injuries (OASIS). Methods Between July 2002 and December 2007 women who attended the perineal clinic at Croydon University Hospital, UK, 9 weeks following primary repair of OASIS were asked to complete the Manchester Health Questionnaire and a questionnaire to obtain a St Mark incontinence score. All women had endoanal scans at this visit. In June 2008 all women were asked to complete the questionnaires again. Results Of 344 patients who responded to the questionnaires and were included in the analysis, long-term symptoms of fecal urgency, flatus incontinence, and fecal incontinence occurred in 62 (18.0%), 52 (15.1%), and 36 (10.5%), respectively. Overall, there was a significant improvement in fecal urgency (P < 0.001) and flatus incontinence (P < 0.001) from 9 weeks to 3 years. Of 31 women with fecal incontinence symptoms at early follow-up, 28 were asymptomatic at 3 years. However, 33 women developed de novo symptoms. The only predictors of fecal incontinence at 3 years were fecal urgency at 9 weeks (OR 4.65; 95% CI, 1.38–15.70) and a higher St Mark score (OR 1.40; 95% CI, 1.09–1.80). Conclusion Following primary repair of OASIS, the majority of symptoms and QoL significantly improve, unless there is a persistent anal sphincter defect. This highlights the importance of adequate repair. PMID:25097141

Reid, Annette J.; Beggs, Andrew D.; Sultan, Abdul H.; Roos, Anne-Marie; Thakar, Ranee

2014-01-01

157

Urethral sphincter EMG-controlled dorsal penile/clitoral nerve stimulation to treat neurogenic detrusor overactivity  

NASA Astrophysics Data System (ADS)

The goal of this study was to investigate whether real-time external urethral sphincter (EUS) EMG-controlled dorsal genital nerve (DGN) stimulation can suppress undesired detrusor bladder contractions in patients with both neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD). Detrusor pressure (Pdet) and EUS EMG were recorded in 12 neurogenic patients who underwent two filling cystometries. The first one was without stimulation and was intended to confirm the NDO and DSD and to set the EMG detection threshold. The second one was with real-time EMG-controlled stimulation of DGNs. Two detection methods were analyzed to detect bladder contractions. The first method was a Kurtosis-scaled root mean square (RMS) detector and was used on-line. The second was a simple RMS detector and was used off-line. Of 12 patients included, 10 patients showed both NDO and DSD. In nine of these ten patients relevant EMG concomitant to detrusor activity was detected and stimulation could suppress at least one detrusor contraction. The second filling compared to the first one showed an increase of 84% in bladder capacity (p = 0.002) and a decrease of 106% in Pdet (p = 0.002). Nine false-positive detections occurred during the ten fillings with electrical stimulation. The mean increases of both time and Pdet between stimulation and bladder contraction onsets for method 1 were 1.8 s and 4 cmH2O and for method 2 were 0.9 s and 2 cmH2O, respectively. This study shows that EUS EMG can be used in real time to detect the onset of a bladder contraction. In combination with DGN stimulation has been shown to be feasible to suppress undesired bladder contractions and in turn to increase bladder capacity in subjects with both NDO and DSD.

Opisso, E.; Borau, A.; Rijkhoff, N. J. M.

2011-06-01

158

Prevalence of Sexual Dysfunctions  

PubMed Central

Ten years of research that has provided data regarding the prevalence of sexual dysfunctions is reviewed. A thorough review of the literature identified 52 studies that have been published in the 10 years since an earlier review by Spector and Carey (1990). Community samples indicate a current prevalence of 0 - 3% for male orgasmic disorder, 0 - 5% for erectile disorder, and 0 - 3% for male hypoactive sexual desire disorder. Pooling current and 1-year figures provides community prevalence estimates of 7 - 10% for female orgasmic disorder and 4 - 5% for premature ejaculation. Stable community estimates of the current prevalence for the other sexual dysfunctions remain unavailable. Prevalence estimates obtained from primary care and sexuality clinic samples are characteristically higher. Although a relatively large number of studies have been conducted since Spector and Carey’s (1990) review, the lack of methodological rigor of many studies limits the confidence that can be placed in these findings. PMID:11329727

Simons, Jeffrey; Carey, Michael P.

2008-01-01

159

Female Sexual Dysfunction  

Microsoft Academic Search

The focus of this book is men and their sexual function and dysfunction, however, many women will also develop some degree\\u000a of sexual health problems concerned with sexual desire, arousal, orgasm, and\\/or pain. The goal is to make relevant evidence-based\\u000a clinical information to help identify and treat specific biologically based pathophysiologies available to the motivated health\\u000a care professional. The prevalence

Irwin Goldstein

160

Post-pyloric feeding  

PubMed Central

Postpyloric feeding is an important and promising alternative to parenteral nutrition. The indications for this kind of feeding are increasing and include a variety of clinical conditions, such as gastroparesis, acute pancreatitis, gastric outlet stenosis, hyperemesis (including gravida), recurrent aspiration, tracheoesophageal fistula and stenosis in gastroenterostomy. This review discusses the differences between pre- and postpyloric feeding, indications and contraindications, advantages and disadvantages, and provides an overview of the techniques of placement of various postpyloric devices. PMID:19294757

Niv, Eva; Fireman, Zvi; Vaisman, Nachum

2009-01-01

161

Opioid-induced bowel dysfunction: pathophysiology and management.  

PubMed

Opioids are the most commonly prescribed medications to treat severe pain in the Western world. It has been estimated that up to 90% of American patients presenting to specialized pain centres are treated with opioids. Along with their analgesic properties, opioids have the potential to produce substantial side effects, such as nausea, cognitive impairment, addiction and urinary retention. In the gut, opioids exert their action on the enteric nervous system, where they bind to the myenteric and submucosal plexuses, causing dysmotility, decreased fluid secretion and sphincter dysfunction, which all leads to opioid-induced bowel dysfunction (OIBD). In the clinic, this is reported as nausea, vomiting, gastro-oesophageal reflux-related symptoms, constipation, etc. One of the most severe symptoms is constipation, which can be assessed using different scales for subjective assessment. Objective methods such as radiography and colonic transit time can also be used, together with manometry and evaluation of anorectal function to explore the pathophysiology. Dose-limiting adverse symptoms of OIBD can lead to insufficient pain treatment. Even though several treatment strategies are available, the side effects are still a major challenge. Traditional laxatives are normally prescribed but they are often insufficient to alleviate symptoms, especially those from the upper gastrointestinal tract. Newer prokinetics, such as prucalopride and lubiprostone, may be more effective in alleviating OIBD. Another treatment approach is co-administration of opioid antagonists, which either cannot cross the blood-brain barrier or selectively target opioid receptors in the gastrointestinal tract. However, although these new agents have proved to be more efficacious than placebo, clinical trials still need to prove their superiority to standard co-prescribed laxative regimes. PMID:22950533

Brock, Christina; Olesen, Søren Schou; Olesen, Anne Estrup; Frøkjaer, Jens Brøndum; Andresen, Trine; Drewes, Asbjørn Mohr

2012-10-01

162

Disturbed Colonic Motility Contributes to Anorectal Symptoms and Dysfunction After Radiotherapy for Carcinoma of the Prostate  

SciTech Connect

Purpose: To evaluate the role of colonic motility in the pathogenesis of anorectal symptoms and dysfunction after radiotherapy (RT) for carcinoma of the prostate. Patients and Methods: Thirty-eight patients, median age 71 (range, 50-81) years with localized prostate carcinoma randomized to one of two radiation dose schedules underwent colonic transit scintigraphy and assessment of anorectal symptoms (questionnaire), anorectal function (manometry), and anal sphincteric morphology (endoanal ultrasound) before and at 1 month and 1 year after RT. Results: Whole and distal colonic transit increased 1 month after RT, with faster distal colonic transit only persisting at 1 year. Frequency and urgency of defecation, fecal incontinence, and rectal bleeding increased 1 month after RT and persisted at 1 year. Basal anal pressures remained unchanged, but progressive reductions occurred in anal squeeze pressures and responses to increased intra-abdominal pressure. Rectal compliance decreased progressively in the patients, although no changes in anorectal sensory function ensued. Radiotherapy had no effect on the morphology of the internal and external anal sphincters. Distal colonic retention was weakly related to rectal compliance at 1 month, but both faster colonic transit and reduced rectal compliance were more frequent with increased fecal urgency. At 1 year, a weak inverse relationship existed between colonic half-clearance time and frequency of defecation, although both faster whole-colonic transit and reduced rectal compliance occurred more often with increased stool frequency. Conclusion: Colonic dysmotility contributes to anorectal dysfunction after RT for carcinoma of the prostate. This has implications for improving the management of anorectal radiation sequelae.

Yeoh, Eric K., E-mail: eric.yeoh@health.sa.gov.a [Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA (Australia); Bartholomeusz, Dylan L. [Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, SA (Australia); Holloway, Richard H. [Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, SA (Australia); Fraser, Robert J. [Gastrointestinal Investigation Unit, Repatriation General Hospital, Daw Park, SA (Australia); Botten, Rochelle; Di Matteo, Addolorata [Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA (Australia); Moore, James W. [Department of Colorectal Surgery, Royal Adelaide Hospital, Adelaide, SA (Australia); Schoeman, Mark N. [Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, SA (Australia)

2010-11-01

163

Palliation of Pyloric Stenosis Caused by Gastric Cancer Using an Endoscopically Placed Covered Ultraflex Stent: Covered Stent Inside an Occluded Uncovered Stent  

SciTech Connect

A 71-year-old man developed pyloric stenosis caused by gastric cancer. Vomiting and nausea resolved after the insertion of an uncovered Ultraflex stent (length 10 cm, inner diameter 18u23 mm) through a 7-cm-long stenosis, and the patient was able to eat a soft diet. After 6 weeks, stent occlusion occurred due to tumor ingrowth and accumulation of food residue. Endoscopic observation showed a very narrow residual lumen. A covered Ultraflex stent (length 10 cm, inner diameter 18u23 mm) was inserted through the first stent and expanded to its maximum diameter over the next 2 days. The patient's vomiting and nausea improved rapidly. He died 6 months after the second stenting procedure, from metastatic tumor spread, having remained free of nausea and vomiting. In this case, a covered metallic stent prevented tumor ingrowth and maintained gastrointestinal patency.

Nakamura, Toshifumi; Kitagawa, Mutsuo; Takehira, Yasunori; Yamada, Masami [Department of Gastroenterology, Hamamatsu Medical Center, 328 Tomitsuka-cho, Hamamatsu, Shizuoka 432-8580 (Japan); Nishiwaki, Yoshiro [Department of Surgery, Hamamatsu Medical Center, 328 Tomitsuka-cho, Hamamatsu, Shizuoka 432-8580 (Japan); Nakamura, Hirotoshi [Second Department of Internal Medicine, Hamamatsu University School of Medicine, 3600 Handa-cho, Hamamatsu, Shizuoka 431-3192 (Japan)

2000-07-15

164

Managing female sexual dysfunction.  

PubMed

Female sexual dysfunctions (FSDs) range from short-term aggravations to major emotional disturbances adversely affecting family and workplace. This review highlights diagnosis and management of the four most widely diagnosed FSDs. It initially focuses on hypoactive sexual desire disorder (HSDD) as a driving force at the heart of all other FSDs; nothing happens without sexual desire. Successful resolution of HSDD frequently facilitates resolution of other disorders. Central to understanding HSDD is the impact of aging female sexual endocrinology and its effect on both prevalence and expression patterns of FSD. Advances in this field have enabled introduction of some the most effective treatments yet described for HSDD. Sexual arousal disorder, though commonly affected by the same factors as HSDD, is heavily associated with psychotropic drugs and mood elevators. Orgasmic disorder is frequently the downstream result of other sexual dysfunctions, particularly HSDD, or the result of a major psychosexual trauma. Successful management of the underlying disorder often resolves orgasmic disorder. Sexual pain disorder is frequently the result of a gynecologic disorder, such as endometriosis, that can be substantially managed through successful treatment of that disorder. This article ends with the article's most important note: how to initiate the conversation. PMID:24074537

Buster, John E

2013-10-01

165

The evaluation of anti-ulcerogenic effect of rhizome starch of two source plants of Tugaksheeree (Curcuma angustifolia Roxb. and Maranta arundinacea Linn.) on pyloric ligated rats  

PubMed Central

Background: In the present era, because of the life-style, the disorders such as hyperacidity and gastric ulcers are found very frequently. Satwa (starch) obtained from the rhizomes of two plants namely Curcuma angustifolia Roxb. and Maranta arundinacea Linn. are used in folklore practice for the treatment of above complaints under the name Tugaksheeree. Aim: To compare the anti-ulcerogenic activity of the above two drugs in pyloric ligation induced gastric ulcer in albino rats. Materials and Methods: A total of 18 Wistar strain albino rats of both sexes grouped into three groups. Group C served as pyloric ligated control group, Group I received starch of C. angustifolia suspension and Group II received starch of M. arundinacea for seven days. On 8th day pylorus was ligated. After ligation the animals were deprived of food and water and sacrificed at the end of 14 h. The collected gastric contents were used for biochemical estimation and ulcer index was calculated from excised stomach. Results: Both the test drugs showed statistically significant decrease in the volume, increase in the pH, reduced the free acidity of gastric juice and decreased the peptic activity. The starch of C. angustifolia reduced a total acidity non-significantly while M. arundinacea reduced it significantly. Among the two drugs the M. arundinacea has effectively reduced the peptic activity, which is statistically significant. M. arundinacea shown statistically significant increase of total carbohydrates. Conclusion: Both the test drugs proved anti-ulcer activity and prevents the chance of gastric ulcer. Among these two M. arundinacea is more effective.

Rajashekhara, N.; Ashok, B. K.; Sharma, Parmeshwar P.; Ravishankar, B.

2014-01-01

166

Assessment and in vitro experiment of artificial anal sphincter system based on rebuilding the rectal sensation function.  

PubMed

In this paper, a novel artificial anal sphincter (AAS) system based on rebuilding the rectal sensation function is proposed to treat human fecal incontinence. The executive mechanism of the traditional AAS system was redesigned and integrated for a simpler structure and better durability. The novel executive mechanism uses a sandwich structure to simulate the basic function of the natural human anal sphincter. To rebuild the lost rectal sensation function caused by fecal incontinence, we propose a novel method for rebuilding the rectal sensation function based on an Optimal Wavelet Packet Basis (OWPB) using the Davies-Bouldin (DB) index and a support vector machine (SVM). OWPB using a DB index is used for feature vector extraction, while a SVM is adopted for pattern recognition.Furthermore, an in vitro experiment with the AAS system based on rectal sensation function rebuilding was carried out. Experimental results indicate that the novel executive mechanism can simulate the basic function of the natural human anal sphincter, and the proposed method is quite effective for rebuilding rectal sensation in patients. PMID:24619902

Zan, Peng; Liu, Jinding; Jiang, Enyu; Wang, Hua

2014-05-01

167

Surgical treatment of tumors of the distal rectum with sphincter preservation.  

PubMed Central

One hundred one patients with villous adenoma or invasive carcinoma of the distal rectum treated with local excision or coloanal anastomosis were studied. Twenty-three (45%) of the 51 patients with villous adenomas had transanal excision, another 23 (45%) had a posterior proctotomy, and five (10%) had a coloanal anastomosis. Only two patients with a villous adenoma developed a recurrence requiring repeat local excision. Fifteen (30%) of the 50 patients with invasive cancer were treated by transanal excision. All had tumors confined to the submucosa or superficial muscularis. Eighteen (85%) of 21 patients having posterior proctotomy also had tumors with similar depth of invasion. Six (43%) of the 14 patients having coloanal anastomosis had Dukes' B tumors, six (43%) were Dukes' C, and another two (14%) underwent palliative resection. The overall actuarial 5-year survival was 77%. Only four patients treated by transanal excision or posterior proctotomy died of metastatic disease. In the coloanal group, two of 12 patients undergoing curative resection died of recurrent cancer, and another has a pelvic recurrence. Villous adenomas of the distal rectum and selected carcinomas may be treated with local excision and coloanal anastomosis with preservation of sphincter function with good results. PMID:1417192

Heimann, T M; Oh, C; Steinhagen, R M; Greenstein, A J; Perez, C; Aufses, A H

1992-01-01

168

Risk Factors for Erosion of Artificial Urinary Sphincters: A Multicenter Prospective Study  

PubMed Central

OBJECTIVE To evaluate the short- to medium-term outcomes after artificial urinary sphincter (AUS) placement from a large, multi-institutional, prospective, follow-up study. We hypothesize that along with radiation, patients with any history of a direct surgery to the urethra will have higher rates of eventual AUS explantation for erosion and/or infection. MATERIALS AND METHODS A prospective outcome analysis was performed on 386 patients treated with AUS placement from April 2009 to December 2012 at 8 institutions with at least 3 months of follow-up. Charts were analyzed for preoperative risk factors and postoperative complications requiring explantation. RESULTS Approximately 50% of patients were considered high risk. High risk was defined as patients having undergone radiation therapy, urethroplasty, multiple treatments for bladder neck contracture or urethral stricture, urethral stent placement, or a history of erosion or infection in a previous AUS. A total of 31 explantations (8.03%) were performed during the follow-up period. Overall explantation rates were higher in those with prior radiation and prior UroLume. Men with prior AUS infection or erosion also had a trend for higher rates of subsequent explantation. Men receiving 3.5-cm cuffs had significantly higher explantation rates than those receiving larger cuffs. CONCLUSION This outcomes study confirms that urethral risk factors, including radiation history, prior AUS erosion, and a history of urethral stent placement, increase the risk of AUS explantation in short-term follow-up. PMID:25109562

Brant, William O.; Erickson, Bradley A.; Elliott, Sean P.; Powell, Christopher; Alsikafi, Nejd; McClung, Christopher; Myers, Jeremy B.; Voelzke, Bryan B.; Smith, Thomas G.; Broghammer, Joshua A.

2015-01-01

169

Design and assessment of novel artificial anal sphincter with adaptive transcutaneous energy transfer system.  

PubMed

Abstract This paper presents the in vitro assessment of a novel elastic scaling artificial anal sphincter system (ES-AASS) with an adaptive transcutaneous energy transfer system (TETS) for treatment of severe faecal incontinence (FI). The proposed adaptive TETS has a phase control, which can maintain the output voltage at ??7?V across the full range of the coupling coefficient variation (from 0.09-0.31) during the whole process of charging with a phase shift of 177.5° to 79.1°. A maximum surface temperature of 42.2?°C was measured above the secondary coil during an energy transmission of 3.5?W in air. The specific absorption rate (SAR) and current density analysis of the biological three-layers structure, including the skin, fat and muscle) surrounding the coil pair were analysed and the results of simulation analysis showed that the value of SAR and current density were very small at any given transmission condition compared with the basic restrictions of the International Commission on Non-Ionizing Radiation Protection (ICNIRP). In conclusion, in vitro experimental results showed that the ES-AASS can control simulated faecal behaviour effectively and the performance of TETS was validated. PMID:25626127

Ke, Lei; Yan, Guozheng; Wang, Zhiwu; Yan, Sheng; Liu, Zhiqiang

2015-02-01

170

Power flow control of TET system for a novel artificial anal sphincter system.  

PubMed

This paper presents an adaptive transcutaneous energy transfer system (TETS) integrated with a novel elastic scaling artificial anal sphincter system (ES-AASS) for treating severe faecal incontinence (FI). The ES-AASS is based on a novel executive mechanism that uses a spring scalable structure to clamp the rectum. To deliver the correct amount of power (i.e. to match the load demand under variable coupling conditions or different operation stages of the implanted device) for internal battery charging and ensure safety for the human body, theoretical analysis was conducted as a control rule with respect to the relationship between the phase of driver signals and output voltage. An easy regulating procedure to stabilize output voltage with a phase shift controller is also presented. To validate the phase control rules, a prototype of the TETS was constructed and its performance was validated across the whole coupling coefficient range (0.09???0.29) as well as load resistance (50???120??). The results show that the output voltage of the secondary side can be maintained at a constant 7?V with a phase regulation range of 78.7-178.2° and the proposed controller has reached a maximal end-to-end power efficiency of 74.2% at 1?W. PMID:25350041

Ke, Lei; Yan, Guozheng; Wang, Zhiwu; Yan, Sheng; Li, Xiyang

2015-01-01

171

Brachytherapy and Local Excision for Sphincter Preservation in T1 and T2 Rectal Cancer  

SciTech Connect

Purpose: To report long-term results of brachytherapy after local excision (LE) in the treatment of T1 and T2 rectal cancer at risk of recurrence due to residual subclinical disease. Methods and Materials: Between 1989 and 2007, 32 patients undergoing LE and brachytherapy were followed prospectively for a mean of 6.2 years. Estimates of local recurrence (LR), disease-specific survival (DSS), and overall survival (OS) were generated. Treatment-related toxicity and the effect of known prognostic factors were determined. Results: There were 8 LR (3 T1, 5 T2), of which 5 were salvaged surgically. Median time to the 8 LR was 14 months, and the 5-year rate of local control was 76%. Although there have been 9 deaths to date, only 5 were from disease. Five-year DSS and OS rates were 85% and 78%, respectively. There were 4 cases of Grade 2-3 radionecrosis and 1 case of mild stool incontinence. The sphincter was preserved in 27 of 32 patients. Conclusion: Local excision and adjuvant brachytherapy for T1 and T2 rectal cancer is an appealing treatment alternative to immediate radical resection, particularly in the frail and elderly who are unable to undergo major surgery, as well as for patients wanting to avoid a permanent colostomy.

Grimard, Laval [Division of Radiation Oncology, Ottawa Hospital, University of Ottawa, Ottawa, Ontario (Canada)], E-mail: lgrimard@ottawahospital.on.ca; Stern, Hartley [Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ontario (Canada); Spaans, Johanna N. M.Sc. [Division of Radiation Oncology, Ottawa Hospital, University of Ottawa, Ottawa, Ontario (Canada)

2009-07-01

172

[Thyroid dysfunction in pregnancy].  

PubMed

Thyroid dysfunction may impair fertility, course of pregnancy and fetal development. Physiological alterations of thyroid function parameters, that occur during pregnancy need to be distinguished from pathophysiological states of hypo- and hyperthyroidism. We performed a literature search (PubMed 1990-2013) and review relevant publications as well as consensus and practice guidelines of international thyroid/endocrine societies. Interpretation of thyroid function values in pregnancy must be based on trimester-specific TSH and T4 ranges. Alterations in thyroid function are present in up to 15% of pregnancies (0.4% overt hypothyroidism, 0.1-0.4% hyperthyroidism) and may lead to preventable complications in the pregnant woman and the fetus. Hypothyroidism is associated with an increased risk for abortion, premature delivery and stillbirth, besides impairment of neurocognitive development. The latter has also been shown in situations of grave iodine deficiency. In addition to new-born screening directed at early recognition of congenital hypothyroidism (incidence 0.03%), universal screening of all pregnant women should be implemented in health care guidelines. Newly diagnosed overt hypothyroidism in a pregnant woman requires immediate levothyroxine substitution at adequate doses. In subclinical hypothyroidism thyroid hormone replacement should be considered. Iodine supplementation is strongly recommended in all pregnant and breast-feeding women. Pregnancy causes a number of, that need to be of thyroid dysfunction. Both hypothyroidism and thyrotoxicosis may impair the course of pregnancy and may negatively affect the fetus. In particular, maternal hypothyroidism may lead to irreparable and detrimental deficits in the neurocognitive development of the fetus. Autoimmune thyroid disease is the most common cause of thyroid dysfunction in pregnancy. Hashimoto's thyroiditis is associated with impaired fertility and miscarriage, and may first manifest in pregnancy due to the increased thyroid hormone requirement. Graves' disease often shows a characteristic course in pregnancy with amelioration of thyrotoxicosis in the second half of pregnancy and exacerbation after delivery. In addition transplacental passage of maternal TSH receptor antibodies may lead to thyrotoxicosis in the fetus and/or newborn. PMID:25289925

Führer, D; Mann, K; Feldkamp, J; Krude, H; Spitzweg, C; Kratzsch, J; Schott, M

2014-10-01

173

Preoperative Radiochemotherapy and Sphincter-Saving Resection for T3 Carcinomas of the Lower Third of the Rectum  

PubMed Central

Objective To evaluate the complications and oncologic and functional results of preoperative radiochemotherapy and sphincter-saving resection for T3 cancers of the lower third of the rectum. Summary Background Data Carcinomas of the lower third of the rectum (i.e., located at or below 6 cm from the anal verge) are usually treated by abdominoperineal resection, especially for T3 lesions. Few data are available evaluating concomitant chemotherapy with preoperative radiotherapy for increasing sphincter-saving resection in low rectal cancer. Methods Between 1995 and 1999, 43 patients underwent preoperative radiochemotherapy with conservative surgery for a low rectal tumor located a mean of 4.5 cm from the anal verge (range 2–6); 70% of the lesions were less than 2 cm from the anal sphincter. There were 40 T3 and 3 T4 tumors. Patients received preoperative radiotherapy with a mean dose of 50 Gy (range 40–54) and concomitant chemotherapy with 5-FU in continuous infusion (n = 36) or bolus (n = 7). Sphincter- saving resection was performed 6 weeks after treatment, in 25 patients by using intersphincteric resection. Coloanal anastomoses were associated with a colonic pouch in 86% of the patients, and all patients had a protecting stoma. Results There were no deaths related to preoperative radiochemotherapy and surgery. Acute toxicity was mainly due to diarrhea, with 54% of grade 1 to 2. Four anastomotic fistulas and two pelvic hematomas occurred; all patients but one had closure of the stoma. Distal and radial surgical margins were respectively 23 ± 8 mm (range 10–40) and 8 ± 4 mm (range 1–20) and were negative in 98% of the patients. Downstaging (pT0–2N0) was observed in 42% of the patients (18/43) and was associated with a greater radial margin (10 vs. 6 mm;P = .02). After a median follow-up of 30 months, the rate of local recurrence was 2% (1/43), and four patients had distal metastases. Overall and disease-free survival rates were both 85% at 3 years. Functional results were good (Kirwan continence I, II) in 79% of the available patients (n = 37). They were slightly altered by intersphincteric resection (57 vs. 75% of perfect continence; NS) but were significantly improved by a colonic pouch (74 vs. 16%;P = .01). Conclusions These results suggest that preoperative radiochemotherapy allowed sphincter-saving resection to be performed with good local control and good functional results in patients with T3 low rectal cancers that would have required abdominoperineal resection in most instances. PMID:11685026

Rullier, Eric; Goffre, Béatrice; Bonnel, Catherine; Zerbib, Frank; Caudry, Michel; Saric, Jean

2001-01-01

174

Investigation of erectile dysfunction  

PubMed Central

Erectile dysfunction (ED) represents a common and debilitating condition with a wide range of organic and non-organic causes. Physical aetiologies can be divided into disorders affecting arterial inflow, the venous occlusion mechanism or the penile structure itself. Various imaging modalities can be utilised to investigate the physical causes of ED, but penile Doppler sonography (PDS) is the most informative technique, indicated in those patients with ED who do not respond to oral pharmacological agents (e.g. phosphodiesterase type 5 inhibitors). This review will examine the anatomical and physiological basis of penile erection, the method for performing PDS and features of specific causes of ED, and will also consider the alternative imaging modalities available. PMID:23118101

Patel, D V; Halls, J; Patel, U

2012-01-01

175

Endothelins & erectile dysfunction.  

PubMed

Erectile dysfunction (ED) is common and a significant contributor to poor quality of life and psychosocial morbidity in men. Normal erectile function requires effective co-ordination between a number of complex neural pathways. Penile tumescence occurs in response to rapid arterial inflow to the corpora cavernosa with simultaneous venous outflow restriction due to expansion of the lacunar spaces. This process is under both central and local neuromediation. Endothelins are potent vasoconstrictor peptides that cause strong, slowly developing but sustained contraction of trabecular smooth muscles cells of the corpora cavernosa. Multiple mechanisms of action are proposed, including transmembrane calcium flux, mobilisation of inositol triphosphate sensitive intracellular calcium stores and calcium sensitisation through the Rho-Rho kinase pathway. The exact role of endothelins in the pathogenesis of ED currently remains unclear. Elevated endothelin-1 levels are found in patients with diabetes mellitus and this alone may be sufficient to cause ED. However, this is not borne out in clinical studies. The resultant elevated intracellular calcium may, however, modulate gene expression sufficiently to cause smooth muscle proliferation. Alternatively, alterations in endothelin receptor sensitivity in conditions such as diabetes and hypertension may enhance vasoconstrictor processes. Currently there is contradictory evidence for the role of endothelin receptor antagonists in ED. Animals studies suggest they inhibit corporal vasoconstriction, improve erectile function and protect against diabetes-induced smooth muscle apoptosis. However, the results of clinical studies in ED have been less promising. Uncertainty regarding the exact role of endothelin in penile erection hampers progress in this area. It is possible that the endothelin system may only be relevant to ED in certain conditions where global endothelial dysfunction exists (e.g. diabetes mellitus, systemic sclerosis) and the use of endothelin antagonists in these patient groups may yield improved outcomes. PMID:21185376

Ritchie, Robert; Sullivan, Mark

2011-06-01

176

Understanding brain dysfunction in sepsis  

PubMed Central

Sepsis often is characterized by an acute brain dysfunction, which is associated with increased morbidity and mortality. Its pathophysiology is highly complex, resulting from both inflammatory and noninflammatory processes, which may induce significant alterations in vulnerable areas of the brain. Important mechanisms include excessive microglial activation, impaired cerebral perfusion, blood–brain-barrier dysfunction, and altered neurotransmission. Systemic insults, such as prolonged inflammation, severe hypoxemia, and persistent hyperglycemia also may contribute to aggravate sepsis-induced brain dysfunction or injury. The diagnosis of brain dysfunction in sepsis relies essentially on neurological examination and neurological tests, such as EEG and neuroimaging. A brain MRI should be considered in case of persistent brain dysfunction after control of sepsis and exclusion of major confounding factors. Recent MRI studies suggest that septic shock can be associated with acute cerebrovascular lesions and white matter abnormalities. Currently, the management of brain dysfunction mainly consists of control of sepsis and prevention of all aggravating factors, including metabolic disturbances, drug overdoses, anticholinergic medications, withdrawal syndromes, and Wernicke’s encephalopathy. Modulation of microglial activation, prevention of blood–brain-barrier alterations, and use of antioxidants represent relevant therapeutic targets that may impact significantly on neurologic outcomes. In the future, investigations in patients with sepsis should be undertaken to reduce the duration of brain dysfunction and to study the impact of this reduction on important health outcomes, including functional and cognitive status in survivors. PMID:23718252

2013-01-01

177

In vitro effect of pantoprazole on lower esophageal sphincter tone in rats  

PubMed Central

AIM: To investigate the in vitro effects of pantoprazole on rat lower esophageal sphincter (LES) tone. METHODS: Rats weighing 250-300 g, provided by the Yeditepe University Experimental Research Center (YÜDETAM), were used throughout the study. They were anesthetized before decapitation. LES tissues whose mucosal lining were removed were placed in a standard 30-mL organ bath with a modified Krebs solution and continuously aerated with 95% oxygen-5% carbon dioxide gas mixture and kept at room temperature. The tissues were allowed to stabilize for 60 min. Subsequently, the contractile response to 10-6 mol/L carbachol was obtained. Different concentrations of freshly prepared pantoprazole were added directly to the tissue bath to generate cumulative concentrations of 5 × 10-6 mol/L, 5 × 10-5 mol/L, and 1.5 × 10-4 mol/L. Activities were recorded on an online computer via a 4-channel transducer data acquisition system using the software BSL PRO v 3.7, which also analyzed the data. RESULTS: Pantoprazole at 5 × 10-6 mol/L caused a small, but statistically insignificant, relaxation in the carbachol-contracted LES (2.23% vs 3.95%). The 5 × 10-5 mol/L concentration, however, caused a significant relaxation of 10.47% compared with the control. 1.5 × 10-4 mol/L concentration of pantoprazol caused a 19.89% relaxation in the carbachol contracted LES (P < 0.001). CONCLUSION: This is the first study to demonstrate that pantoprazole has a relaxing effect in isolated LESs. These results might have significant clinical implications for the subset of patients using proton pump inhibitors who do not receive full symptomatic alleviation from gastroesophageal reflux disease. PMID:22171145

Duman, Mustafa; Özer, Mahmut; Reyhan, Enver; Demirci, Yeliz; At?c?, Ali E; Dalg?ç, Tahsin; Bostanc?, Erdal B; Genç, Ece

2011-01-01

178

Peripheral N-methyl-D-aspartate receptors modulate nonadrenergic noncholinergic lower esophageal sphincter relaxation in rabbits.  

PubMed

We investigated the role of peripheral N-methyl-D-aspartate (NMDA) receptors in the myenteric plexus in mediating nonadrenergic noncholinergic (NANC) nitrergic relaxation of the lower esophageal sphincter (LES). Isometric contraction of LES strips from Japanese White rabbits was measured. NANC relaxation was induced by KCl (30 mM) in the presence of atropine and guanethidine. The concentration of 3',5'-cyclic guanosine monophosphate (cGMP) was measured using a radioimmunoassay. The muscle strips were exposed to diethyldithiocarbamic acid (DETCA; 3 mM) to inactivate Cu/Zn superoxide dismutase. MK801 (5-methyl-10,11-dihydroxy-5H-dibenzo(a,d)cyclohepten-5,10-imine) inhibited NANC relaxation in a concentration-dependent manner (EC50 = 1.5 x 10(-5) M), accompanied by a decrease in cGMP production. NMDA induced a concentration-dependent relaxation, which was antagonized by MK801. NMDA stimulated cGMP production, which was inhibited by N(G)-nitro-L-arginine. Superoxide dismutase (100 U/mL) shifted the concentration-response relationship of MK801-mediated inhibition of NANC relaxation to the right (EC50 = 3.4 x 10(-5) M), whereas catalase did not. Treatment with DETCA shifted the concentration-response relationships of pyrogallol-, ketamine- and MK801-mediated inhibition of NANC relaxation to the left. These findings suggest that the peripheral NMDA receptors mediate NANC smooth muscle relaxation, and modulate it, in part, through extracellular production of superoxide anions, thus eliminating the relaxant effect of endogenous nitric oxide. PMID:16301241

Kohjitani, Atsushi; Funahashi, Makoto; Miyawaki, Takuya; Hanazaki, Motohiko; Matsuo, Ryuji; Shimada, Masahiko

2005-12-01

179

The Association of Episiotomy with Obstetric Anal Sphincter Injury–A Population Based Matched Cohort Study  

PubMed Central

Objectives To estimate the independent association of episiotomy with obstetric anal sphincter injuries (OASIS) using first a cross-sectional and then a matched pair analysis. Design A matched cohort. Setting Data was gathered from the Finnish Medical Birth Register from 2004–2011. Population All singleton vaginal births (n?=?303,758). Methods Women resulting matched pairs (n?=?63,925) were matched based on baseline risk of OASIS defined based on parity (first or second/subsequent vaginal births), age, birth weight, mode of delivery, prior caesarean section, and length of active second stage of birth. Results In cross-sectional analysis episiotomy was associated with a 12% lower incidence of OASIS (adjusted odds ratio (aOR) 0.88, 95% confidence interval (CI) 0.80 to 0.98) in first vaginal births and with a 132% increased incidence of OASIS in second or subsequent vaginal births (aOR 2.32, 95% CI 1.77 to 3.03). In matched pair analysis episiotomy was associated with a 23% (aOR 0.77, 95% CI 0.69 to 0.86) lower incidence of OASIS in first vaginal births and a 61% (aOR 1.61, 95% CI 1.14 to 2.29) increased incidence of OASIS in second or subsequent vaginal births compared to women who gave birth without an episiotomy. The matched pair analysis showed a 12.5% and a 31.6% reduction in aORs of OASIS associated with episiotomy, respectively. Conclusions A matched pair analysis showed a substantial reduction in the aORs of OASIS with episiotomy, due to confounding by indication. This indicates that results of observational studies evaluating an association between episiotomy and OASIS should be interpreted with caution. PMID:25203655

Räisänen, Sari; Selander, Tuomas; Cartwright, Rufus; Gissler, Mika; Kramer, Michael R.; Laine, Katariina; Heinonen, Seppo

2014-01-01

180

Comparing Argus sling and artificial urinary sphincter in patients with moderate post-prostatectomy incontinence  

PubMed Central

Post-prostatectomy incontinence (PPI) is a main complication of radical prostatectomy. The purpose of this study was to compare the efficacy and safety of the Argus male sling (Argus) with that of artificial urinary sphincters (AUS) in patients with moderate PPI. A total of 33 moderate PPI patients underwent AUS or Argus implantation from January 2009 to June 2013 (13 AUS, 20 Argus). We defined moderate PPI as the use of 2–4 pads per day. To compare efficacy, we assessed the success rate between the two groups. Success was defined as the daily need for no pads or one small safety pad that remained dry most of the day. The mean patient age was 73.5±6.3 yr in the AUS group and 70.9±5.1 yr in the Argus group, and the mean follow-up period was 29.8±14.9 months in the AUS group and 24.7±11.8 months in the Argus group. The success rate was 72.7% in the AUS group and 85.0% in the Argus group (P=0.557). Abnormal postoperative pain persisted in more patients in the Argus group (6/20, 30%) than in the AUS group (1/13, 7.7%) (P=0.126). However, the rate of other complications was not different between the two groups (7.7% and 15.0% for AUS and Argus, respectively, P=0.822). Argus surgery showed similar success and complication rates to those of AUS in moderate PPI patients, indicating that it could be an alternative surgical option for the treatment of moderate PPI. PMID:25426474

Lim, Bumjin; Kim, Aram; Song, Miho; Chun, Ji-Youn; Park, Junsoo; Choo, Myung-Soo

2014-01-01

181

Lower esophageal sphincter relaxation is impaired in older patients with dysphagia  

PubMed Central

AIM: To characterize the effects of age on the mechanisms underlying the common condition of esophageal dysphagia in older patients, using detailed manometric analysis. METHODS: A retrospective case-control audit was performed on 19 patients aged ? 80 years (mean age 85 ± 0.7 year) who underwent a manometric study for dysphagia (2004-2009). Data were compared with 19 younger dysphagic patients (32 ± 1.7 years). Detailed manometric analysis performed prospectively included basal lower esophageal sphincter pressure (BLESP), pre-swallow and nadir LESP, esophageal body pressures and peristaltic duration, during water swallows (5 mL) in right lateral (RL) and upright (UR) postures and with solids. Data are mean ± SE; a P-value < 0.05 was considered significant. RESULTS: Elderly dysphagic patients had higher BLESP than younger patients (23.4 ± 3.8 vs 14.9 ± 1.2 mmHg; P < 0.05). Pre-swallow LESP was elevated in the elderly in both postures (RL: 1 and 4 s P = 0.019 and P = 0.05; UR: P < 0.05 and P = 0.05) and solids (P < 0.01). In older patients, LES nadir pressure was higher with liquids (RL: 2.3 ± 0.6 mmHg vs 0.7 ± 0.6 mmHg, P < 0.05; UR: 3.5 ± 0.9 mmHg vs 1.6 ± 0.5 mmHg, P = 0.01) with shorter relaxation after solids (7.9 ± 1.5 s vs 9.7 ± 0.4 s, P = 0.05). No age-related differences were seen in esophageal body pressures or peristalsis duration. CONCLUSION: Basal LES pressure is elevated and swallow-induced relaxation impaired in elderly dysphagic patients. Its contribution to dysphagia and the effects of healthy ageing require further investigation. PMID:21455332

Besanko, Laura K; Burgstad, Carly M; Mountifield, Reme; Andrews, Jane M; Heddle, Richard; Checklin, Helen; Fraser, Robert JL

2011-01-01

182

Myoarchitectural and functional alterations in rabbit external anal sphincter muscle following experimental surgical trauma.  

PubMed

Obstetrical trauma to external anal sphincter (EAS) is extremely common; however, its role in the development of anal incontinence is not clear. We examined the regenerative process and functional impact of experimental surgical trauma to EAS muscle in an animal model. Surgical myotomy, a craniocaudal incision extending along the entire length and thickness of the EAS, was performed in rabbits. Animals were allowed to recover, and anal pressures were recorded at weekly intervals for 12 wk using a custom-designed probe system to determine the length-tension property of EAS muscle. Animals were killed at predetermined time intervals, and the anal canal was harvested for histochemical studies (for determination of muscle/connective tissue/collagen) and sarcomere length measurement. In addition, magnetic resonance diffusion tensor imaging (MR-DTI) and fiber tracking was performed to determine myoarchitectural changes in the EAS. Myotomy of the EAS muscle resulted in significant impairment of its length-tension property that showed only partial recovery during the 12-wk study period. Histology revealed marked increase in the fibrosis (connective tissue = 69% following myotomy vs. 28% in controls) at 3 wk, which persisted at 12 wk. Immunostaining studies confirmed deposition of collagen in the fibrotic tissue. There was no change in the sarcomere length following myotomy. MR-DTI studies revealed disorganized muscle fiber orientation in the regenerating muscle. We conclude that, following experimental injury, the EAS muscle heals with an increase in the collagen content and loss of normal myoarchitecture, which we suspect is the cause of impaired EAS function. PMID:24994856

Rajasekaran, M Raj; Sinha, Shantanu; Seo, Youngjin; Salehi, Mitra; Bhargava, Valmik; Mittal, Ravinder K

2014-08-15

183

Neuronal mediators of inhibitory junction potentials and relaxation in the guinea-pig internal anal sphincter.  

PubMed Central

1. Inhibitory junction potentials (IJPs) and relaxations evoked in response to field stimulation (supramaximal voltage, 0.1 ms, single stimulus and 5 stimuli at 5-40 Hz) of non-adrenergic non-cholinergic (NANC) nerves with atropine and phentolamine (each 1 microM) were measured in the guinea-pig internal anal sphincter (gpIAS). The mean resting membrane potential was -44.2 +/- 0.2 mV (n = 1119 cells from 260 preparations). 2. NANC nerve stimulation evoked frequency-dependent IJPs (19.7 +/- 1.1 mV, n = 165, 33 tissues to a single stimulus) and relaxations. IJPs consisted of two tetrodotoxin (1 microM)-sensitive components: one was abolished by apamin (0.3 microM) and the P2-purinoceptor antagonist suramin (100 microM); the other, smaller in amplitude, was sensitive to inhibitors of nitric oxide synthase (NOS, e.g. L-NAME, 100 microM) and the nitric oxide (NO) scavenger oxyhaemoglobin (HbO, 10 microM). 3. ATP (1 mM), vasoactive intestinal polypeptide (VIP, 0.01-0.25 microM) and pituitary adenylate cyclase-activating peptide (PACAP(1-27), 0.84 microM) each hyperpolarized and relaxed the gpIAS; only ATP responses resembled the evoked IJPs in time course. 4. The guanylyl cyclase inhibitor LY83583 (10 microM) abolished apamin-insensitive IJPs and relaxations. The cGMP phosphodiesterase inhibitor M&B 22948 (30 microM) and 8-Br-cGMP (100 microM) each hyperpolarized the gpIAS. 5. Two components comprise the IJP and relaxation evoked in response to NANC nerve stimulation in the gpIAS. One, sensitive to apamin, resembles the response to ATP and is modulated by purinoceptor antagonists; the other, apamin and suramin insensitive, is inhibited by NO antagonists. PMID:8782113

Rae, M G; Muir, T C

1996-01-01

184

Prevention of Esophagopharyngeal Reflux by Augmenting the Upper Esophageal Sphincter Pressure Barrier  

PubMed Central

Objectives/Hypothesis Incompetence of the upper esophageal sphincter (UES) is fundamental to the occurrence of esophagopharyngeal reflux (EPR), and development of supraesophageal manifestations of reflux disease (SERD). However, therapeutic approaches to SERD have not been directed to strengthening of the UES barrier function. Our aims were to demonstrate that EPR events can be experimentally induced in SERD patients and not in healthy controls, and ascertain if these events can be prevented by application of a modest external cricoid pressure. Study Design Individual case control study. Methods We studied 14 SERD patients (57±13 years, 8 females) and 12 healthy controls (26±3 years, 7 females) by concurrent intraesophageal slow infusion and pharyngoscopic and manometric technique without and with the application of a sustained predetermined cricoid pressure to induce, detect, and prevent EPR, respectively. Results Slow esophageal infusion (1 mL/s) of 60 mL of HCl resulted in a total of 16 objectively confirmed EPR events in none patients and none in healthy controls. All patients developed subjective sensation of regurgitation. Sustained cricoid pressure resulted in a significant UES pressure augmentation in all participants. During application of sustained cricoid pressure, slow intraesophageal infusion resulted in only one EPR event (P<.01). Conclusions Slow esophageal liquid infusion unmasks UES incompetence evidenced as the occurrence of EPR. Application of 20 to 30 mm Hg cricoid pressure significantly increases the UES intraluminal pressure and prevents pharyngeal reflux induced by esophageal slow liquid infusion. These techniques can be useful in diagnosis and management of UES incompetence in patients suffering from supraesophageal manifestations of reflux disease. PMID:24782387

Shaker, Reza; Babaei, Arash; Naini, Sohrab R.

2015-01-01

185

Strapping for temporomandibular joint dysfunction.  

PubMed

Temporomandibular joint dysfunction (TMJD) is a common problem seen in many of the dental clinics. Management of this depends on an accurate diagnosis of the cause for the TMJD. Physical therapy and rehabilitation play a vital role in the management of these dysfunctions. Physical therapy is useful in treating post-traumatic stiffness of the TMJ while strapping of the TMJ for a dysfunction along with conventional physical therapy is of benefit in terms of reduction in click, decrease in pain, and an improvement in function. PMID:18797110

Babu, Abraham Samuel; John, Sandhya Mary; Unni, Amith

2008-01-01

186

Mitochondrial dysfunction in gliomas.  

PubMed

Mitochondrial (mt) dysfunction in gliomas has been linked to abnormalities of mt energy metabolism, marked by a metabolic shift from oxidative phosphorylation to glycolysis ("Warburg effect"), disturbances in mt membrane potential regulation and apoptotic signaling, as well as to somatic mutations involving the Krebs cycle enzyme isocitrate dehydrogenase. Evolving biological concepts with potential therapeutic implications include interaction between microtubule proteins and mitochondria (mt) in the control of closure of voltage-dependent anion channels and in the regulation of mt dynamics and the mt-endoplasmic reticulum network. The cytoskeletal protein ?III-tubulin, which is overexpressed in malignant gliomas, has emerged as a prosurvival factor associated in part with mt and also as a marker of chemoresistance. Mt-targeted therapeutic strategies that are discussed include the following: (1) metabolic modulation with emphasis on dichloroacetate, a pyruvate dehydrogenase kinase inhibitor; (2) tumor cell death via apoptosis induced by tricyclic antidepressants, microtubule-modulating drugs, and small molecules or compounds capable of inflicting reactive oxygen species-dependent tumor cell death; and (3) pretreatment mt priming and mt-targeted prodrug cancer therapy. PMID:24331363

Katsetos, Christos D; Anni, Helen; Dráber, Pavel

2013-09-01

187

Psychoanalysis: a dysfunctional family?  

PubMed

The discussion opens with an account of the author's mother's bizarre family in which a strong, charismatic grandmother maintained absolute control over her large family by encouraging a neurotic dependence in them through daily reports of their complaints. Getting interested in psychoanalysis in an effort to understand the dynamics of this dysfunctional family, the author, a biographer, turned to the study of Melanie Klein, becoming entranced by her ideas. Her research also revealed how Klein had discouraged her followers from developing ideas that diverged in any way from her own. Her portrait of the pioneer analyst provoked intense indignation. A similar pattern of absolute loyalty to his person and theories was to be found in Freud's Secret Committee, formed primarily as a means of getting rid of Jung who had been showing disturbing signs of independence. When Ferenczi and Rank began to pursue independent lines of enquiry in their work, they too were though to be undermining the foundations of classical psychoanalysis. Finally, the author concludes that though there have been sorry incidents in psychoanalysis, we should be mature enough to accept both the contributions of the early pioneers and the realizations that new ideas must be permitted to evolve. PMID:9531859

Grosskurth, P

1998-01-01

188

Posterior Tibial Tendon Dysfunction (PTTD)  

MedlinePLUS

... ACFAS | Información en Español Advanced Search Home » Foot & Ankle Conditions » Posterior Tibial Tendon Dysfunction (PTTD) Text Size ... the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change. ...

189

The gonyautoxin 2/3 epimers reduces anal tone when injected in the anal sphincter of healthy adults.  

PubMed

The primary clinical symptom of Paralytic Shellfish Poisoning is acute paralytic illness produced by paralyzing toxins. Paralytic shellfish poison is formed by a mixture of phycotoxins and their toxicity is due to its reversible binding to a receptor site on the voltage-gated sodium channel on excitable cells, thus blocking neuronal transmission. We studied the effect of the gonyautoxin 2/3 epimers by local infiltration in the anal internal sphincter of healthy voluntary adults in order to reduce anal tone. The toxin was injected after prior clinical evaluation, anoscopy and anorectal manometry. Post injection clinical examination, electromyography and anorectal manometry were performed. Resting and voluntary contraction pressures were measured and the anorectal inhibitory and anocortical reflexes were tested by manometry. Blood and urine samples were obtained from each participant, and hemogram, basic metabolic panel, and urinalysis were done both before and one week after the injection. This study shows, for the first time, that gonyautoxin 2/3 reduces the anal tone by relaxing the anal sphincters in 100 % of the participants. Manometric recordings showed a significant decrease in anal maximal voluntary contraction pressure after the toxin injection, dropping to 55.2+/-6.2 % and 47.0+/-6.8% (Mean Value+/-Std.Dev.) of the baseline values at 2 minutes and at 24 hours respectively after the injection. Post-injection electromyography showed that activity of the muscle was abolished. We conclude that local administration of gonyautoxin 2/3 to the anal sphincter produces immediate relaxation and a statistically significant decrease in the anal tone (p <0.001). PMID:15515965

Garrido, Rogelio; Lagos, Néstor; Lattes, Karinna; Azolas, Carlos García Rodrigo; Bocic, Gunther; Cuneo, Aldo; Chiong, Hector; Jensen, Cristian; Henríquez, Ana I; Fernández, Cristian

2004-01-01

190

Evaluation of Male Sexual Dysfunction  

Microsoft Academic Search

\\u000a The management of male sexual dysfunction and specifically erectile dysfunction (ED) has seen major changes in each decade\\u000a since the 1970s thanks to the discovery that a papaverine injection could produce erection, the NIH Consensus Statement which\\u000a defined ED in 1992, advances in minimally invasive diagnostics, and the development of orally effective erectogenic class\\u000a of drugs, the phosphodiesterase type-5 inhibitors

Gregory A. Broderick

191

Defining Pelvic Factors in Sphincter-Preservation of Low Rectal Cancer with a Three-Dimensional Digital Model of Pelvis  

Microsoft Academic Search

\\u000a Purpose  Surgeons often can contribute failure of sphincter-preserving procedure to a limitation of pelvis anatomy; however, they cannot\\u000a determine definitely which anatomic diameter or spatial factor actually affected the success of the procedure.\\u000a \\u000a \\u000a \\u000a Methods  Colorectal surgeons, radiologists, and research fellows collaborated closely to establish a three-dimensional digital model\\u000a of the pelvis with spiral computerized tomography scanning data of patients with rectal cancer.

Jin Gu; Xue Feng Bo; Chun Yang Xiong; Ai Wen Wu; Xiao Peng Zhang; Ming Li; Qi An; Jing Fang; Jie Li; Xuan Zhang; Hong Yi Wang; Fei Gao; Wei Cheng You

2006-01-01

192

Can the risk of obstetric anal sphincter injuries (OASIs) be predicted using a risk-scoring system?  

PubMed Central

Background Perineal trauma involving the anal sphincter is an important complication of vaginal delivery. Prediction of anal sphincter injuries may improve the prevention of anal sphincter injuries. Our aim was to construct a risk scoring model to assist in both prediction and prevention of Obstetric Anal Sphincter Injuries (OASIs). We carried out an analysis of factors involved with OASIs, and tested the constructed model on new patient data. Methods Data on all vaginal deliveries over a 5 year period (2004–2008) was obtained from the electronic maternity record system of one institution in the UK. All risk factors were analysed using logistic regression analysis. Odds ratios for independent variables were then used to construct a risk scoring algorithm. This algorithm was then tested on subsequent vaginal deliveries from the same institution to predict the incidence of OASIs. Results Data on 16,920 births were analysed. OASIs occurred in 616 (3.6%) of all vaginal deliveries between 2004 and 2008. Significant (p < 0.05) variables that increased the risk of OASIs on multivariate analysis were: African-Caribbean descent, water immersion in labour, water birth, ventouse delivery, forceps delivery. The following variables remained independently significant in decreasing the risk of OASIs: South Asian descent, vaginal multiparity, current smoker, home delivery. The subsequent odds ratios were then used to construct a risk-scoring algorithm that was tested on a separate cohort of patients, showing a sensitivity of 52.7% and specificity of 71.1%. Conclusions We have confirmed known risk factors previously associated with OASIs, namely parity, birth weight and use of instrumentation during delivery. We have also identified several previously unknown factors, namely smoking status, ethnicity and water immersion. This paper identifies a risk scoring system that fulfils the criteria of a reasonable predictor of the risk of OASIs. This supersedes current practice where no screening is implemented other than examination at the time of delivery by a single examiner. Further prospective studies are required to assess the clinical impact of this scoring system on the identification and prevention of third degree tears. PMID:25056485

2014-01-01

193

Continuous urinary incontinence presenting as the initial symptoms demonstrating acontractile detrusor and intrinsic sphincter deficiency in multiple system atrophy.  

PubMed

Severe stress incontinence due to intrinsic sphincter deficiency may be common in aged women. However stress urinary incontinence could be the initial symptom of severe neurogenic bladder even if no neurological signs have previously been recognized. Urodynamic study is necessary in such a case. Tension-free vaginal tape surgery and intermittent self-catheterization may be one option, but self catheterization might become difficult when the neurological disorders develop. In this case report, we highlight the need for caution in identifying the presence of an occult neurogenic bladder when intending to carry out surgery for patients with severe stress incontinence. PMID:17880306

Mashidori, Tomoko; Yamanishi, Tomonori; Yoshida, Ken-Ichiro; Sakakibara, Ryuji; Sakurai, Kunihiko; Hirata, Koichi

2007-10-01

194

Complications of gastroesophageal reflux disease. Role of the lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and duodenogastric reflux.  

PubMed Central

The factors contributing to the development of esophageal mucosal injury in gastroesophageal reflux disease (GERD) are unclear. The lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and the presence of excessive duodenogastric reflux (DGR) was evaluated in 205 consecutive patients with GERD and various degrees of mucosal injury (no mucosal injury, n = 92; esophagitis, n = 66; stricture, n = 19; Barrett's esophagus, n = 28). Manometry and 24-hour esophageal pH monitoring showed that the prevalence and severity of esophageal mucosal injury was higher in patients with a mechanically defective lower esophageal sphincter (p less than 0.01) or increased esophageal acid/alkaline exposure (p less than 0.01) as compared with those with a normal sphincter or only increased esophageal acid exposure. Complications of GERD were particularly frequent and severe in patients who had a combination of a defective sphincter and increased esophageal acid/alkaline exposure (p less than 0.01). Combined esophageal and gastric pH monitoring showed that esophageal alkaline exposure was increased only in GERD patients with DGR (p less than 0.05) and that DGR was more frequent in GERD patients with a stricture or Barrett's esophagus. A mechanically defective lower esophageal sphincter and reflux of acid gastric juice contaminated with duodenal contents therefore appear to be the most important determinants for the development of mucosal injury in GERD. This explains why some patients fail medical therapy and supports the surgical reconstruction of the defective sphincter as the most effective therapy. PMID:1632700

Stein, H J; Barlow, A P; DeMeester, T R; Hinder, R A

1992-01-01

195

Neoadjuvant therapy followed by local excision and two-stage total mesorectal excision: a new strategy for sphincter preservation in locally advanced ultra-low rectal cancer  

PubMed Central

Background: With the increased usage of neoadjuvant chemoradiotherapy, improved surgical technique and stapling devices, sphincter-preserving resection has become more frequent for patients with rectal cancer. However, as for locally advanced ultra-low rectal cancer, sphincter-preservation is still facing an enormous challenge. Objective: To introduce an NLT strategy of sphincter-preservation—neoadjuvant therapy (NT) followed by local excision (LE) and two-stage total mesorectal excision (TME)—into the treatment of locally advanced ultra-low rectal cancer (lesions with anal sphincter invasion). Methods: From October 2010 to October 2011, nine patients with locally advanced rectal cancer located less than 3 cm from the anal verge were treated by the NLT strategy. All patients had shown good clinical response to NT. The LE procedure was carried transanally 6–8 weeks after completion of the NT. TME was performed to dissect mesorectal lymph nodes 4–6 weeks after LE. Results: Of the nine patients, the lesion was assessed as T2 in two, T3 in five, and T4 in two before NT, and lymph node metastasis was detected in five patients. The median distance from the tumor to the anal verge was 2.5 cm (range: 1–3 cm). The median follow-up was 27 months (range: 24–34 months). No distant metastasis was detected. Only one patient (11.1%) developed local recurrence at 12 months post-operatively and then underwent abdomino-perineal resection. The remaining eight patients had preserved long-term continence and the median Wexner score at two years post-operation was 4 (range: 2–6). Conclusion: The new NLT strategy can achieve sphincter-preservation in some patients with ultra-low rectal cancer, with favorable oncological outcome and preservation of normal anal sphincter function. PMID:24760235

Wang, Ting; Wang, Jianping; Deng, Yanhong; Wu, Xiaojian; Wang, Lei

2014-01-01

196

Upper esophageal sphincter mechanical states analysis: a novel methodology to describe UES relaxation and opening  

PubMed Central

The swallowing muscles that influence upper esophageal sphincter (UES) opening are centrally controlled and modulated by sensory information. Activation of neural inputs to these muscles, the intrinsic cricopharyngeus muscle and extrinsic suprahyoid muscles, results in their contraction or relaxation, which changes the diameter of the lumen, alters the intraluminal pressure and ultimately inhibits or promotes flow of content. This relationship that exists between the changes in diameter and concurrent changes in intraluminal pressure has been used previously to calculate the “mechanical states” of the muscle; that is when the muscles are passively or actively, relaxing or contracting. Diseases that alter the neural pathways to these muscles can result in weakening the muscle contractility and/or decreasing the muscle compliance, all of which can cause dysphagia. Detecting these changes in the mechanical state of the muscle is difficult and as the current interpretation of UES motility is based largely upon pressure measurement (manometry), subtle changes in the muscle function during swallow can be missed. We hypothesized that quantification of mechanical states of the UES and the pressure-diameter properties that define them, would allow objective characterization of the mechanisms that govern the timing and extent of UES opening during swallowing. To achieve this we initially analyzed swallows captured by simultaneous videofluoroscopy and UES pressure with impedance recording. From these data we demonstrated that intraluminal impedance measurements could be used to determine changes in the internal diameter of the lumen when compared to videofluoroscopy. Then using a database of pressure-impedance studies, recorded from young and aged healthy controls and patients with motor neuron disease, we calculated the UES mechanical states in relation to a standardized swallowed bolus volume, normal aging and dysphagia pathology. Our results indicated that eight different mechanical states were almost always seen during healthy swallowing and some of these calculated changes in muscle function were consistent with the known neurally dependent phasic discharge patterns of cricopharyngeus muscle activity during swallowing. Clearly defined changes in the mechanical states were observed in motor neuron disease when compared to age matched healthy controls. Our data indicate that mechanical state predictions were simple to apply and revealed patterns consistent with the known neural inputs activating the different muscles during swallowing. PMID:25610376

Omari, Taher I.; Wiklendt, Lukasz; Dinning, Philip; Costa, Marcello; Rommel, Nathalie; Cock, Charles

2015-01-01

197

A novel pattern of longitudinal muscle contraction with subthreshold pharyngeal stimulus: a possible mechanism of lower esophageal sphincter relaxation  

PubMed Central

A subthreshold pharyngeal stimulus induces lower esophageal sphincter (LES) relaxation and inhibits progression of ongoing peristaltic contraction in the esophagus. Recent studies show that longitudinal muscle contraction of the esophagus may play a role in LES relaxation. Our goal was to determine whether a subthreshold pharyngeal stimulus induces contraction of the longitudinal muscle of the esophagus and to determine the nature of this contraction. Studies were conducted in 16 healthy subjects. High resolution manometry (HRM) recorded pressures, and high frequency intraluminal ultrasound (HFIUS) images recorded longitudinal muscle contraction at various locations in the esophagus. Subthreshold pharyngeal stimulation was induced by injection of minute amounts of water in the pharynx. A subthreshold pharyngeal stimulus induced strong contraction and caudal descent of the upper esophageal sphincter (UES) along with relaxation of the LES. HFIUS identified longitudinal muscle contraction of the proximal (3–5 cm below the UES) but not the distal esophagus. Pharyngeal stimulus, following a dry swallow, blocked the progression of dry swallow-induced peristalsis; this was also associated with UES contraction and descent along with the contraction of longitudinal muscle of the proximal esophagus. We identify a unique pattern of longitudinal muscle contraction of the proximal esophagus in response to subthreshold pharyngeal stimulus, which we propose may be responsible for relaxation of the distal esophagus and LES through the stretch sensitive activation of myenteric inhibitory motor neurons. PMID:22173917

Leslie, Eric; Bhargava, Valmik

2012-01-01

198

Argon Plasma Coagulation Therapy Versus Topical Formalin for Intractable Rectal Bleeding and Anorectal Dysfunction After Radiation Therapy for Prostate Carcinoma  

SciTech Connect

Purpose: To evaluate and compare the effect of argon plasma coagulation (APC) and topical formalin for intractable rectal bleeding and anorectal dysfunction associated with chronic radiation proctitis. Methods and Materials: Thirty men (median age, 72 years; range, 49-87 years) with intractable rectal bleeding (defined as ?1× per week and/or requiring blood transfusions) after radiation therapy for prostate carcinoma were randomized to treatment with APC (n=17) or topical formalin (n=13). Each patient underwent evaluations of (1) anorectal symptoms (validated questionnaires, including modified Late Effects in Normal Tissues–Subjective, Objective, Management, and Analytic and visual analogue scales for rectal bleeding); (2) anorectal motor and sensory function (manometry and graded rectal balloon distension); and (3) anal sphincteric morphology (endoanal ultrasound) before and after the treatment endpoint (defined as reduction in rectal bleeding to 1× per month or better, reduction in visual analogue scales to ?25 mm, and no longer needing blood transfusions). Results: The treatment endpoint was achieved in 94% of the APC group and 100% of the topical formalin group after a median (range) of 2 (1-5) sessions of either treatment. After a follow-up duration of 111 (29-170) months, only 1 patient in each group needed further treatment. Reductions in rectal compliance and volumes of sensory perception occurred after APC, but no effect on anorectal symptoms other than rectal bleeding was observed. There were no differences between APC and topical formalin for anorectal symptoms and function, nor for anal sphincteric morphology. Conclusions: Argon plasma coagulation and topical formalin had comparable efficacy in the durable control of rectal bleeding associated with chronic radiation proctitis but had no beneficial effect on anorectal dysfunction.

Yeoh, Eric, E-mail: eric.yeoh@health.sa.gov.au [Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide (Australia); School of Medicine, University of Adelaide, Adelaide (Australia); Tam, William; Schoeman, Mark [School of Medicine, University of Adelaide, Adelaide (Australia); Department of Gastroenterology, Royal Adelaide Hospital, Adelaide (Australia); Moore, James; Thomas, Michelle [School of Medicine, University of Adelaide, Adelaide (Australia); Department of Colorectal Surgery, Royal Adelaide Hospital, Adelaide (Australia); Botten, Rochelle; Di Matteo, Addolorata [Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide (Australia)

2013-12-01

199

Swallowing dysfunction after critical illness.  

PubMed

Critical care practitioners must frequently make decisions about their patients' ability to swallow food, liquids, and pills. These decisions can be particularly difficult given the incompletely defined epidemiology, diagnostic criteria, and prognostic features of swallowing disorders in critically ill patients. Furthermore, the consequences of improper decisions-namely, aspiration, malnutrition, hunger, and thirst-can be devastating to patients and their families. This review outlines the problem of swallowing dysfunction in critically ill patients and then addresses the most clinically relevant questions that critical care practitioners face today. First, we review the epidemiology of swallowing dysfunction in critically ill patients. Next, we describe the different diagnostic tests for swallowing dysfunction and describe a general approach to the initial assessment for swallowing disorders. Finally, we explore the existing treatments for swallowing dysfunction. Given the burden of swallowing dysfunction in patients recovering from critical illness, enabling critical care practitioners to manage these disorders, while stimulating new investigation into their pathophysiology, diagnosis, and management, will enhance our care of critically ill patients. PMID:25451355

Macht, Madison; White, S David; Moss, Marc

2014-12-01

200

Does stress induce bowel dysfunction?  

PubMed

Psychological stress is known to induce somatic symptoms. Classically, many gut physiological responses to stress are mediated by the hypothalamus-pituitary-adrenal axis. There is, however, a growing body of evidence of stress-induced corticotrophin-releasing factor (CRF) release causing bowel dysfunction through multiple pathways, either through the HPA axis, the autonomic nervous systems, or directly on the bowel itself. In addition, recent findings of CRF influencing the composition of gut microbiota lend support for the use of probiotics, antibiotics, and other microbiota-altering agents as potential therapeutic measures in stress-induced bowel dysfunction. PMID:24881644

Chang, Yu-Ming; El-Zaatari, Mohamad; Kao, John Y

2014-08-01

201

Impact of Endoscopic Suturing of the Gastroesophageal Junction on Lower Esophageal Sphincter Function and Gastroesophageal Reflux in Patients with Reflux Disease  

Microsoft Academic Search

OBJECTIVES:Plication of the gastroesophageal junction by endoscopic suturing has been reported to improve symptoms and reduce acid exposure in patients with gastroesophageal reflux disease (GERD). The mechanisms underlying these effects are not well defined. The aims of our study were to determine the impact of endoscopic suturing of the gastroesophageal junction on lower esophageal sphincter (LES) function in patients with

William C. E. Tam; Richard H. Holloway; John Dent; Rachael Rigda; Mark N. Schoeman

2004-01-01

202

Bioengineering of physiologically functional intrinsically innervated human internal anal sphincter constructs.  

PubMed

Muscle replacement for patients suffering from extensive tissue loss or dysfunction is a major objective of regenerative medicine. To achieve functional status, bioengineered muscle replacement constructs require innervation. Here we describe a method to bioengineer functionally innervated gut smooth muscle constructs using neuronal progenitor cells and smooth muscle cells isolated and cultured from intestinal tissues of adult human donors. These constructs expressed markers for contractile smooth muscle, glial cells, and mature neuronal populations. The constructs responded appropriately to physiologically relevant neurotransmitters, and neural network integration was demonstrated by responses to electrical field stimulation. The ability of enteric neuroprogenitor cells to differentiate into neuronal populations provides enormous potential for functional innervation of a variety of bioengineered muscle constructs in addition to gut. Functionally innervated muscle constructs offer a regenerative medicine-based therapeutic approach for neuromuscular replacement after trauma or degenerative disorders. PMID:24328537

Gilmont, Robert R; Raghavan, Shreya; Somara, Sita; Bitar, Khalil N

2014-06-01

203

Sexual dysfunctions of the alcoholic  

Microsoft Academic Search

After reviewing the theories proposed as models for alcoholism, a picture seems to emerge that may serve to incorporate the sexual dysfunctions occuring in chronic alcoholism. So far, neither the clinical anecdotal data, nor the recent research on non-alcoholics conducted in controlled laboratory conditions could explain the persistence of sexual ysfunctions after years of sobriety. The seemingly paradoxical appearance, during

Irene Gad-Luther

1980-01-01

204

Chemotherapy-associated renal dysfunction  

Microsoft Academic Search

The presence of renal dysfunction in a patient receiving chemotherapy can be devastating. Although many patients with cancer have underlying compromised renal function, some chemotherapeutic agents can actually induce renal abnormalities. An understanding of which traditional and newer chemotherapy agents can affect renal function is useful for physicians so that they can monitor patients for renal abnormalities and initiate preventive

Vaibhav Sahni; Devasmita Choudhury; Ziauddin Ahmed

2009-01-01

205

Dysfunctional beliefs discriminate personality disorders  

Microsoft Academic Search

This study examines whether specific sets of dysfunctional beliefs are differentially associated with five personality disorders (PDs) as predicted by cognitive theory. Seven hundred fifty-six psychiatric outpatients completed the Personality Belief Questionnaire (PBQ) at intake and were assessed for PDs using a standardized clinical interview conducted by assessors who were blind to patients' PBQ responses. Findings showed that patients with

Aaron T. Beck; Andrew C. Butler; Gregory K. Brown; Katherine K. Dahlsgaard; Cory F. Newman; Judith S. Beck

2001-01-01

206

Photobiomodulation on alcohol induced dysfunction  

NASA Astrophysics Data System (ADS)

Alcohol, which is ubiquitous today, is a major health concern. Its use was already relatively high among the youngest respondents, peaked among young adults, and declined in older age groups. Alcohol is causally related to more than 60 different medical conditions. Overall, 4% of the global burden of disease is attributable to alcohol, which accounts for about as much death and disability globally as tobacco and hypertension. Alcohol also promotes the generation of reactive oxygen species (ROS) and/or interferes with the body's normal defense mechanisms against these compounds through numerous processes, particularly in the liver. Photobiomodulation (PBM) is a cell-specific effect of low intensity monochromatic light or low intensity laser irradiation (LIL) on biological systems. The cellular effects of both alcohol and LIL are ligand-independent so that PBM might rehabilitate alcohol induced dysfunction. The PBM on alcohol induced human neutrophil dysfunction and rat chronic atrophic gastritis, the laser acupuncture on alcohol addiction, and intravascular PBM on alcoholic coma of patients and rats have been observed. The endonasal PBM (EPBM) mediated by Yangming channel, autonomic nervous systems and blood cells is suggested to treat alcohol induced dysfunction in terms of EPBM phenomena, the mechanism of alcohol induced dysfunction and our biological information model of PBM. In our opinion, the therapeutic effects of PBM might also be achieved on alcoholic myopathy.

Yang, Zheng-Ping; Liu, Timon C.; Zhang, Yan; Wang, Yan-Fang

2007-05-01

207

Bowel dysfunction in fibromyalgia syndrome  

Microsoft Academic Search

Fibromyalgia and irritable bowel syndrome frequently coexist. In this study, we utilized a previously validated self-administered questionnaire to assess the prevalence of symptoms of bowel dysfunction and irritable bowel syndrome in 123 patients with fibromyalgia as compared to 54 patients with degenerative joint disease (DJD) and 46 normal controls. Ninety (73%) of the fibromyalgia patients reported altered bowel function as

George Triadafilopoulos; Robert W. Simms; Don L. Goldenberg

1991-01-01

208

Assessing mitochondrial dysfunction in cells  

PubMed Central

Assessing mitochondrial dysfunction requires definition of the dysfunction to be investigated. Usually, it is the ability of the mitochondria to make ATP appropriately in response to energy demands. Where other functions are of interest, tailored solutions are required. Dysfunction can be assessed in isolated mitochondria, in cells or in vivo, with different balances between precise experimental control and physiological relevance. There are many methods to measure mitochondrial function and dysfunction in these systems. Generally, measurements of fluxes give more information about the ability to make ATP than do measurements of intermediates and potentials. For isolated mitochondria, the best assay is mitochondrial respiratory control: the increase in respiration rate in response to ADP. For intact cells, the best assay is the equivalent measurement of cell respiratory control, which reports the rate of ATP production, the proton leak rate, the coupling efficiency, the maximum respiratory rate, the respiratory control ratio and the spare respiratory capacity. Measurements of membrane potential provide useful additional information. Measurement of both respiration and potential during appropriate titrations enables the identification of the primary sites of effectors and the distribution of control, allowing deeper quantitative analyses. Many other measurements in current use can be more problematic, as discussed in the present review. PMID:21726199

Brand, Martin D.; Nicholls, David G.

2011-01-01

209

The neuropathy of erectile dysfunction  

Microsoft Academic Search

These studies were intended to explore the relationship between autonomic neuropathy and erectile dysfunction (ED). Sensory thresholds reflecting the integrity of both large diameter, myelinated neurons (ie pressure, touch, vibration) and small diameter axons (ie hot and cold thermal sensation) were determined on the penis and finger. Data were compared across subjects with and without ED, controlling for age, hypertension

CB Bleustein; JC Arezzo; H Eckholdt; A Melman

2002-01-01

210

VOIDING DYSFUNCTION AFTER BILATERAL EXTRAVESICAL URETERAL REIMPLANTATION  

Microsoft Academic Search

PurposeVoiding dysfunction has been reported after bilateral extravesical ureteral reimplantation. We evaluate the incidence and duration of voiding dysfunction, and the effects of minimizing surgical dissection in a cohort of children after bilateral extravesical reimplantation.

BETH A. LIPSKI; MICHAEL E. MITCHELL; MARK W. BURNS

1998-01-01

211

The clinical pattern of duodenogastric bile reflux in the Kenyan Africans.  

PubMed

Forty consecutive African patients found to have duodenogastric bile reflux at endoscopy were studied. Bile reflux was found more commonly among males than females, giving a male/female ratio of 2.3:1, with a peak age at 41-60 years. ABO blood groups had no significant influence on duodenogastric bile reflux. Flatulence and borborygmi were the most consistent symptoms other than the classical dyspeptic pain pattern. Bilious vomiting was a rare finding. Duodenogastric bile reflux was more commonly associated with endoscopic gastritis (67.5%), gastric ulcer (35%) and oesophagitis (30%) than with duodenal ulcer (22.5%), deformed pyloric ring (5%) or distorted duodenal bulb (2.5%). The dysfunction in the pyloric sphincter in people with duodenogastric bile reflux appears to be more of a physiological defect than structural. PMID:2917497

Ogutu, E O; Lule, G N; Okoth, F; Mwai, S J

1989-01-01

212

Clinical evaluation of a single daily dose of phenylpropanolamine in the treatment of urethral sphincter mechanism incompetence in the bitch  

PubMed Central

The objective of this retrospective study was to determine the efficacy of a single daily oral dose of phenylpropanolamine (PPA) in the treatment of urethral sphincter mechanism incompetence (USMI) in bitches. Nine bitches diagnosed with USMI were treated with a single daily dose [1.5 mg/kg body weight (BW)] of PPA for at least 1 month. Urethral pressure profiles (UPP) were performed in 7 dogs before treatment and repeated in 4 of them after treatment. Treatment with PPA resulted in long-term continence in 8/9 bitches. One dog did not respond to PPA and was treated surgically later. Recheck UPPs showed a significant increase in maximal urethral closure pressure in the 4 bitches after treatment with PPA compared to before treatment. In conclusion, long-term continence can be achieved in bitches affected with USMI after administration of a single daily dose of PPA (1.5 mg/kg BW). PMID:22043069

Claeys, Stéphanie; Rustichelli, Frederico; Noël, Stéphanie; Hamaide, Annick

2011-01-01

213

[Tiropramide chlorhydrate in premedication for endoscopic retrograde cholangiopancreatography and its effects on the motor activity of Oddi's sphincter].  

PubMed

The activity of tiropramide chlorhydrate in the pre-medication for the endoscopical examinations has been evaluated. In particular ERCP has been studied considering as parameters the timing of the different stages of the examination and the activity of Oddi's sphincter. At the end of endoscopy the pressure of the sphincterial region was measured a 3-way miniature catheter. Patients included in the study were divided into two different groups: group A treated with tiropramide chlorhydrate and diazepam vs group B treated only with diazepam. The group with patients pre-medicated with tiropramide chlorhydrate presented a significant reduction in the timing of the different stages of endoscopy. Endoscopy was better tolerated. Manometry showed an antispastic action of the drug without side effects. An important reduction of the degree and duration of the sphincterial phase activity, with a possible improvement of biliary defluxion into the duodenum, was observed. PMID:3822221

Bolognese, A; Lamazza, A; Tocchi, A; Bruni, C; Crimi, M R; Fontana, B; De Masi, E

1987-03-15

214

Complications After Sphincter-Saving Resection in Rectal Cancer Patients According to Whether Chemoradiotherapy Is Performed Before or After Surgery  

SciTech Connect

Purpose: The aim of the present study was to compare the influence of preoperative chemoradiotherapy (CRT) with postoperative CRT on the incidence and types of postoperative complications in rectal cancer patients who underwent sphincter-saving resection. Patients and Methods: We reviewed 285 patients who received preoperative CRT and 418 patients who received postoperative CRT between January 2000 and December 2006. Results: There was no between-group difference in age, gender, or cancer stage. In the pre-CRT group, the mean level of anastomosis from the anal verge was lower (3.5 {+-} 1.4 cm vs. 4.3 {+-} 1.7 cm, p < 0.001) and the rate of T4 lesion and temporary diverting ileostomy was higher than in the post-CRT group. Delayed anastomotic leakage and rectovaginal fistulae developed more frequently in the pre-CRT group than in the post-CRT group (3.9% vs. 1.2%, p = 0.020, 6.5% vs. 1.3%, p = 0.027, respectively). Small bowel obstruction (arising from radiation enteritis) requiring surgical intervention was more frequent in the post-CRT group (0% in the pre-CRT group vs. 1.4% in the post-CRT group, p = 0.042). Multivariate analysis identified preoperative CRT as an independent risk factor for fistulous complications (delayed anastomotic leakage, rectovaginal fistula, rectovesical fistula), and postoperative CRT as a risk factor for obstructive complications (anastomotic stricture, small bowel obstruction). The stoma-free rates were significantly lower in the pre-CRT group than in the post-CRT group (5-year stoma-free rates: 92.8% vs. 97.0%, p = 0.008). Conclusion: The overall postoperative complication rates were similar between the pre-CRT and the Post-CRT groups. However, the pattern of postoperative complications seen after sphincter- saving resection differed with reference to the timing of CRT.

Kim, Chan Wook [Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of); Kim, Jong Hoon [Department of Radiation Oncology, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of); Yu, Chang Sik, E-mail: csyu@amc.seoul.k [Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of); Shin, Ui Sup; Park, Jin Seok; Jung, Kwang Yong [Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of); Kim, Tae Won [Department of Medical Oncology, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of); Yoon, Sang Nam; Lim, Seok-Byung; Kim, Jin Cheon [Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of)

2010-09-01

215

A new technique for sphincter-preserving anal fistula repair using a novel radial emitting laser probe.  

PubMed

Anal fistula repair still remains challenging. Up to 30% of fistulas persist after surgery despite many improvements in surgical skills and technique. One major reason for surgical failure is a persistent fistula track or remnants of the fistula epithelium which could not be removed during surgery. To overcome this problem, a novel technique was developed using a newly invented radial emitting laser probe ("FiLaC™", Biolitec, Germany) to destroy the fistula epithelium and to simultaneously obliterate the remaining fistula track. In a pilot study, we operated on 11 patients with cryptoglandular anal fistula. All patients underwent previous surgery up to 6 times prior to definitive surgery. In the primary operation, the initial abscess was drained, the internal opening of the fistula identified and seton drainage placed. During fistula repair, we used the flap technique for conventional closure of the internal opening. The remaining fistula track was cleaned mechanically, the laser inserted into the track and energy applied homogeneously at a wavelength of 1,470 nm and 13 watt. While providing continuous retraction of the probe, the remaining epithelium was destroyed and the fistula track obliterated. The median follow-up was 7.4 months. Nine out of 11 fistulas showed primary healing (81.8%). Only one minor form of incontinence (limited soiling) was observed and no complications occurred. The use of a novel diode laser source and a radial emitting laser probe in addition to conventional surgery is a very promising new technique in sphincter-preserving anal fistula repair. The observed healing rate is high. Due to minimized trauma to the sphincter muscle, there are good short-term functional results without observable procedure-related complications. PMID:21845480

Wilhelm, A

2011-12-01

216

Mitochondrial dysfunction affects chloroplast functions  

PubMed Central

The transcriptomic response of A9:u-ATP9 and apetala3:u-ATP9 lines carrying a mitochondrial dysfunction in flower tissues has been characterized. Both lines showed an alteration in the transcription of several genes involved in carbon and nitrogen metabolism, stress responses, transcription factors and DNA binding proteins. Interestingly, several transcripts of photosynthetic-related genes were also affected in their expression such as the mRNAs encoding for chlorophyllase, chlorophyll binding proteins and a PSII. Moreover, chlorophyll levels were reduced and the Mg-dechelatase activity was increased, indicating an alteration in chlorophyll metabolism. Our results suggest that the mitochondrial dysfunction may also affect chloroplastic functions, and that our model could be useful to uncover retrograde signaling mechanisms operating between the three different plant genomes. PMID:22101346

Busi, Maria V.; Gomez-Lobato, Maria E.; Araya, Alejandro; Gomez-Casati, Diego F.

2011-01-01

217

Mitochondrial dysfunction affects chloroplast functions.  

PubMed

The transcriptomic response of A9:u-ATP9 and apetala3:u-ATP9 lines carrying a mitochondrial dysfunction in flower tissues has been characterized. Both lines showed an alteration in the transcription of several genes involved in carbon and nitrogen metabolism, stress responses, transcription factors and DNA binding proteins. Interestingly, several transcripts of photosynthetic-related genes were also affected in their expression such as the mRNAs encoding for chlorophyllase, chlorophyll binding proteins and a PSII. Moreover, chlorophyll levels were reduced and the Mg-dechelatase activity was increased, indicating an alteration in chlorophyll metabolism. Our results suggest that the mitochondrial dysfunction may also affect chloroplastic functions, and that our model could be useful to uncover retrograde signaling mechanisms operating between the three different plant genomes. PMID:22101346

Busi, Maria V; Gomez-Lobato, Maria E; Araya, Alejandro; Gomez-Casati, Diego F

2011-12-01

218

MUTANT HUNTINGTIN AND MITOCHONDRIAL DYSFUNCTION  

PubMed Central

Huntington's disease (HD) is a fatal inherited neurodegenerative disorder that gradually robs affected individuals of memory, cognitive skills, and normal movements. While research has identified a single faulty gene, the huntingtin gene, as the cause of the disease, a cure remains elusive. Strong evidence indicates that mitochondrial impairment plays a key role in HD pathogenesis. Here, we highlight how mtHtt might cause mitochondrial dysfunction by either perturbing transcription of nuclear-encoded mitochondrial proteins or by direct interaction with the organelle and modulation of respiration, membrane potential and Ca2+ buffering. In addition, we propose that mtHtt might convey its neurotoxicity by evoking defects in mitochondrial dynamics, organelle trafficking and fission and fusion, which in turn might result in bioenergetic failure and HD-linked neuronal dysfunction and cell death. Finally, we speculate how mitochondria may dictate selective vulnerability of long projection neurons, such as medium spiny neurons, which are particularly affected in HD. PMID:18951640

Bossy-Wetzel, Ella; Petrilli, Alejandra; Knott, Andrew B.

2008-01-01

219

Autonomic dysfunction in neurodegenerative dementias.  

PubMed

Syncope associated to orthostatic hypotension (OH), urinary incontinence and constipation is common symptoms in demented patients, mainly in dementia with Lewy bodies (DLB) and in Parkinson's disease dementia (PDD). Alzheimer's disease (AD) and fronto temporal lobar degeneration (FTLD) show less autonomic dysfunction. Urinary symptoms are a prominent component of normal pressure hydrocephalus (NPH). There are non invasive tests including standard cardiovascular tests, 123 I-metaiodobenzylguanide (MIBG) cardiac scintigraphy, urodynamic tests, gastrointestinal motility studies, sweating reflexes and pupillary responses that assess autonomic dysfunction in these patients. The study of autonomic symptoms and abnormal tests in patients with dementia is useful to prevent morbidity due falls, severe constipation and to avoid side effects of drugs that interfere with autonomic function. PMID:21440258

Idiaquez, Juan; Roman, Gustavo C

2011-06-15

220

Mitochondria: Redox Metabolism and Dysfunction  

PubMed Central

Mitochondria are the main intracellular location for fuel generation; however, they are not just power plants but involved in a range of other intracellular functions including regulation of redox homeostasis and cell fate. Dysfunction of mitochondria will result in oxidative stress which is one of the underlying causal factors for a variety of diseases including neurodegenerative diseases, diabetes, cardiovascular diseases, and cancer. In this paper, generation of reactive oxygen/nitrogen species (ROS/RNS) in the mitochondria, redox regulatory roles of certain mitochondrial proteins, and the impact on cell fate will be discussed. The current state of our understanding in mitochondrial dysfunction in pathological states and how we could target them for therapeutic purpose will also be briefly reviewed. PMID:22593827

Kang, Jia; Pervaiz, Shazib

2012-01-01

221

Mitochondrial dysfunction and organophosphorus compounds  

SciTech Connect

Organophosphorous (OPs) pesticides are the most widely used pesticides in the agriculture and home. However, many acute or chronic poisoning reports about OPs have been published in the recent years. Mitochondria as a site of cellular oxygen consumption and energy production can be a target for OPs poisoning as a non-cholinergic mechanism of toxicity of OPs. In the present review, we have reviewed and criticized all the evidences about the mitochondrial dysfunctions as a mechanism of toxicity of OPs. For this purpose, all biochemical, molecular, and morphological data were retrieved from various studies. Some toxicities of OPs are arisen from dysfunction of mitochondrial oxidative phosphorylation through alteration of complexes I, II, III, IV and V activities and disruption of mitochondrial membrane. Reductions of adenosine triphosphate (ATP) synthesis or induction of its hydrolysis can impair the cellular energy. The OPs disrupt cellular and mitochondrial antioxidant defense, reactive oxygen species generation, and calcium uptake and promote oxidative and genotoxic damage triggering cell death via cytochrome C released from mitochondria and consequent activation of caspases. The mitochondrial dysfunction induced by OPs can be restored by use of antioxidants such as vitamin E and C, alpha-tocopherol, electron donors, and through increasing the cytosolic ATP level. However, to elucidate many aspect of mitochondrial toxicity of Ops, further studies should be performed. - Highlights: • As a non-cholinergic mechanism of toxicity, mitochondria is a target for OPs. • OPs affect action of complexes I, II, III, IV and V in the mitochondria. • OPs reduce mitochondrial ATP. • OPs promote oxidative and genotoxic damage via release of cytochrome C from mitochondria. • OP-induced mitochondrial dysfunction can be restored by increasing the cytosolic ATP.

Karami-Mohajeri, Somayyeh [Department of Toxicology and Pharmacology, Faculty of Pharmacy, and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran (Iran, Islamic Republic of); Department of Toxicology and Pharmacology, Faculty of Pharmacy, and Pharmaceutical Sciences Research Center, Kerman University of Medical Sciences, Kerman (Iran, Islamic Republic of); Abdollahi, Mohammad, E-mail: Mohammad.Abdollahi@UToronto.Ca [Department of Toxicology and Pharmacology, Faculty of Pharmacy, and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran (Iran, Islamic Republic of)

2013-07-01

222

Insulin dysfunction and Tau pathology  

PubMed Central

The neuropathological hallmarks of Alzheimer's disease (AD) include senile plaques of ?-amyloid (A?) peptides (a cleavage product of the Amyloid Precursor Protein, or APP) and neurofibrillary tangles (NFT) of hyperphosphorylated Tau protein assembled in paired helical filaments (PHF). NFT pathology is important since it correlates with the degree of cognitive impairment in AD. Only a small proportion of AD is due to genetic variants, whereas the large majority of cases (~99%) is late onset and sporadic in origin. The cause of sporadic AD is likely to be multifactorial, with external factors interacting with biological or genetic susceptibilities to accelerate the manifestation of the disease. Insulin dysfunction, manifested by diabetes mellitus (DM) might be such factor, as there is extensive data from epidemiological studies suggesting that DM is associated with an increased relative risk for AD. Type 1 diabetes (T1DM) and type 2 diabetes (T2DM) are known to affect multiple cognitive functions in patients. In this context, understanding the effects of diabetes on Tau pathogenesis is important since Tau pathology show a strong relationship to dementia in AD, and to memory loss in normal aging and mild cognitive impairment. Here, we reviewed preclinical studies that link insulin dysfunction to Tau protein pathogenesis, one of the major pathological hallmarks of AD. We found more than 30 studies reporting Tau phosphorylation in a mouse or rat model of insulin dysfunction. We also payed attention to potential sources of artifacts, such as hypothermia and anesthesia, that were demonstrated to results in Tau hyperphosphorylation and could major confounding experimental factors. We found that very few studies reported the temperature of the animals, and only a handful did not use anesthesia. Overall, most published studies showed that insulin dysfunction can promote Tau hyperphosphorylation and pathology, both directly and indirectly, through hypothermia. PMID:24574966

El Khoury, Noura B.; Gratuze, Maud; Papon, Marie-Amélie; Bretteville, Alexis; Planel, Emmanuel

2013-01-01

223

Psychological Aspects of Erectile Dysfunction  

Microsoft Academic Search

\\u000a Because the brain is intimately involved in the control of erections, a wide variety of psychological factors impact erectile\\u000a response and may lead to erectile dysfunction (ED). This chapter reviews the assessment of psychological factors in ED, the\\u000a immediate and underlying psychological conditions involved, and the development of ED over time. Outcome research on psychological\\u000a treatments for ED is also

Richard A. Carroll

224

Thyroid Dysfunction from Antineoplastic Agents  

PubMed Central

Unlike cytotoxic agents that indiscriminately affect rapidly dividing cells, newer antineoplastic agents such as targeted therapies and immunotherapies are associated with thyroid dysfunction. These include tyrosine kinase inhibitors, bexarotene, radioiodine-based cancer therapies, denileukin diftitox, alemtuzumab, interferon-?, interleukin-2, ipilimumab, tremelimumab, thalidomide, and lenalidomide. Primary hypothyroidism is the most common side effect, although thyrotoxicosis and effects on thyroid-stimulating hormone secretion and thyroid hormone metabolism have also been described. Most agents cause thyroid dysfunction in 20%–50% of patients, although some have even higher rates. Despite this, physicians may overlook drug-induced thyroid dysfunction because of the complexity of the clinical picture in the cancer patient. Symptoms of hypothyroidism, such as fatigue, weakness, depression, memory loss, cold intolerance, and cardiovascular effects, may be incorrectly attributed to the primary disease or to the antineoplastic agent. Underdiagnosis of thyroid dysfunction can have important consequences for cancer patient management. At a minimum, the symptoms will adversely affect the patient’s quality of life. Alternatively, such symptoms can lead to dose reductions of potentially life-saving therapies. Hypothyroidism can also alter the kinetics and clearance of medications, which may lead to undesirable side effects. Thyrotoxicosis can be mistaken for sepsis or a nonendocrinologic drug side effect. In some patients, thyroid disease may indicate a higher likelihood of tumor response to the agent. Both hypothyroidism and thyrotoxicosis are easily diagnosed with inexpensive and specific tests. In many patients, particularly those with hypothyroidism, the treatment is straightforward. We therefore recommend routine testing for thyroid abnormalities in patients receiving these antineoplastic agents. PMID:22010182

Larsen, P. Reed; Marqusee, Ellen

2011-01-01

225

Pre-clinical diastolic dysfunction.  

PubMed

Pre-clinical diastolic dysfunction (PDD) has been broadly defined as left ventricular diastolic dysfunction without the diagnosis of congestive heart failure (HF) and with normal systolic function. PDD is an entity that remains poorly understood, yet has definite clinical significance. Although few original studies have focused on PDD, it has been shown that PDD is prevalent, and that there is a clear progression from PDD to symptomatic HF including dyspnea, edema, and fatigue. In diabetic patients and in patients with coronary artery disease or hypertension, it has been shown that patients with PDD have a significantly higher risk of progression to heart failure and death compared with patients without PDD. Because of these findings and the increasing prevalence of the heart failure epidemic, it is clear that an understanding of PDD is essential to decreasing patients' morbidity and mortality. This review will focus on what is known concerning pre-clinical diastolic dysfunction, including definitions, staging, epidemiology, pathophysiology, and the natural history of the disease. In addition, given the paucity of trials focused on PDD treatment, studies targeting risk factors associated with the development of PDD and therapeutic trials for heart failure with preserved ejection fraction will be reviewed. PMID:24291270

Wan, Siu-Hin; Vogel, Mark W; Chen, Horng H

2014-02-11

226

Gastrointestinal dysfunction in liver cirrhosis.  

PubMed

Patients with liver cirrhosis exhibit several features of gut dysfunction which may contribute to the development of cirrhosis complications as well as have an impact on nutritional status and health-related quality of life. Gastrointestinal symptoms are common in cirrhosis and their pathophysiology probably involves factors related to liver disease severity, psychological distress, and gut dysfunction (e.g., increased gastric sensitivity to distension and delayed gut transit). They may lead to reduced food intake and, thus, may contribute to the nutritional status deterioration in cirrhotic patients. Although tense ascites appears to have a negative impact on meal-induced accommodation of the stomach, published data on gastric accommodation in cirrhotics without significant ascites are not unanimous. Gastric emptying and small bowel transit have generally been shown to be prolonged. This may be related to disturbances in postprandial glucose, insulin, and ghrelin levels, which, in turn, appear to be associated to insulin resistance, a common finding in cirrhosis. Furthermore, small bowel manometry disturbances and delayed gut transit may be associated with the development of small bowel bacterial overgrowth. Finally, several studies have reported intestinal barrier dysfunction in patients with cirrhosis (especially those with portal hypertension), which is related to bacterial translocation and permeation of intestinal bacterial products, e.g., endotoxin and bacterial DNA, thus potentially being involved in the pathogenesis of complications of liver cirrhosis. PMID:25356031

Kalaitzakis, Evangelos

2014-10-28

227

Autonomic dysfunction in Parkinson's disease.  

PubMed

This article is a review of autonomic dysfunction in idiopathic Parkinson's disease (iPD), as well as the clinical features of a specific form of PD, i.e. autonomic failure (AF) with PD, and is based mainly on the results obtained from our recent studies. Since James Parkinson's original discription, the definition of autonomic dysfunctions in iPD and their clinical characteristics have undergone changes. Autonomic dysfunction is considered to be uncommon and rarely severe on one hand, while not infrequent but not as severe as in Shy-Drager syndrome on the other hand. AF with PD is characterized by severe orthostatic hypotension, postprandial hypotension, supersensitivity to noradrenaline, low or absent uptake of m-[123I]iodobenzylguanidine scintigraphy of the limbs, and preserved arginine vasopressin response to head-up tilt, suggesting a postganglionic sympathetic lesion resembling pure AF (PAF). On the other hand, reduced cortical glucose metabolism in positron emission tomography study may indicate that AF with PD has diffuse nervous system lesions resembling diffuse Lewy body disease. PMID:9387797

Koike, Y; Takahashi, A

1997-01-01

228

Pharmacotherapy of Sexual Dysfunctions : Current Status  

PubMed Central

The sexual dysfunctions are one of the most prevalent conditions. Sexual dysfunctions can have profound effect on the psychological well-being of an individual and the psychosexual relationship of a couple. Management of the sexual dysfunction should be preceded by an accurate diagnosis reached after a complete medical and sexual history and physical examination. Current focus of researchers has been on understanding the pathophysiology of erectile dysfunction, premature ejaculation and other sexual dysfunctions that can help in developing newer pharmacological cures for these conditions. Recently, a number of clinical trials have studied the potential effectiveness of the phosphodiesterase (PDE)-5 inhibitor sildenafil in the treatment of Erectile Dysfunction (ED) and Premature Ejaculation (PME). The introduction of PDE-5 inhibitors like sildenafil, vardenafil and tadalafil has revolutionized the treatment of sexual dysfunctions. This review focuses on the recent pharmacological advances in the treatment of common sexual dysfunctions like ED and PME with special focus on the role of PDE-5 inhibitors. Also discussed is the pharmacological treatment of other less prevalent and recognized disorders like female sexual dysfunction, drug induced sexual dysfunction etc. PMID:21224902

Avasthi, Ajith; Biswas, Parthasarathy

2004-01-01

229

The role of pelvic-floor therapy in the treatment of lower urinary tract dysfunctions in children.  

PubMed

The pelvic-floor is under voluntary control and plays an important role in the pathophysiology of lower urinary tract (LUT) dysfunctions in children, especially of non-neuropathic bladder sphincter dysfunction. The following therapeutic measures can be applied to try to influence the activity of the pelvic-floor during voiding: proprioceptive exercises of the pelvic-floor (manual testing), visualization of the electromyographic registration of relaxation and contraction of the pelvic-floor by a curve on a display (relaxation biofeedback), observation of the flow curve during voiding (uroflow biofeedback), learning of an adequate toilet posture in order to reach an optimal relaxation of the pelvic-floor, an individually adapted voiding and drinking schedule to teach the child to deal consciously with the bladder and its function and a number of simple rules for application at home to increase the involvement and motivation of the child. In children however with persisting idiopathic detrusor instability additional therapeutic measures may be necessary to improve present urologic symptoms (incontinence problems, frequency, urge) and to increase bladder capacity. Intravesical biofeedback has been used to stretch the bladder and seems to be useful in case of sensory urge. Recently a less invasive technique, called transcutaneous electrical nerve stimulation (TENS), has been applied on level of S3 with promising results in children with urodynamicaly proven detrusor instability, in which previous therapies have failed. PMID:12201917

De Paepe, H; Renson, C; Hoebeke, P; Raes, A; Van Laecke, E; Vande Walle, J

2002-01-01

230

Rle de l'innervation enkphalinergique dans la commande nerveuse du sphincter anal interne chez le chat, par J. C. GRIMAUD, M. BOUVIER, G. KIRSCHNER, et J. GONELLA.J. C. GRIMAUD, M. BOUVIER, G. KIRSCHNER, J. GONELLA.  

E-print Network

Rôle de l'innervation enképhalinergique dans la commande nerveuse du sphincter anal interne chez le-Aiguier, 13402 Mar- seille Cedex 9. Le sphincter anal interne (SA!), qui est la portion la plus extrême du muscle enképhalinergiques sont impliqués dans un réflexe inhibiteur vésico-anal Bouvier et Grimaud (1984). Dans le but d

Paris-Sud XI, Université de

231

Is a New High-Resolution Probe Better than the Standard Probe for 3D Anal Sphincter and Levator Ani Imaging?  

PubMed

The aim of our study was to determine the accuracy of a new three-dimensional (3D) endoluminal ultrasound probe in assessing the levator ani muscle and anal sphincter complex. A total of 85 patients who had undergone concurrent 3D endovaginal (EVUS) and 3D endoanal (EAUS) ultrasound with both the standard BK 2052 probe and the new high-definition BK 8838 probes were included. For EVUS volumes, the levator ani deficiency (LAD) scores were calculated for each probe. For the EAUS volumes, any defects in the external anal sphincter (EAS) and the internal anal sphincter (IAS) visualized with each probe were recorded. The 3D volumes were evaluated in a blinded fashion. Appropriate statistics were utilized to assess absolute agreements between each pair of imaging modalities. The mean age of the patient population was 59 years (SD ± 10.76), the mean body mass index (BMI) was 28.36 (SD ± 5.99), and the median parity was 2 (range 1, 7). In all, 93% of the patients were Caucasian, 31% had stage 0 or 1 prolapse, while 59% had stage 2 prolapse. The mean total LAD score obtained on EVUS with the standard and the new probes were 11.49 (SD ± 4.94) and 11.53 (SD ± 5.01), respectively, p = 0.3778. Among the 53 patients who had EAUS with both probes, exact agreement for visualization of EAS and IAS for the standard and the new probes was 83% and 98%, respectively. Both transducers can be used for endovaginal imaging of the levator ani muscles interchangeably. Both transducers can be used for endoanal imaging of anal sphincter complex interchangeably. PMID:24831299

Rostaminia, Ghazaleh; White, Dena; Quiroz, Lieschen; Shobeiri, S Abbas

2014-05-14

232

Increased motor unit fibre density in the external anal sphincter muscle in ano-rectal incontinence: a single fibre EMG study  

Microsoft Academic Search

The motor unit fibre density in the external anal sphincter muscle has been measured in 13 normal subjects aged 18 to 78 years, and in 14 patients with ano-rectal incontinence, aged 17 to 72 years. The mean fibre density in the normal subjects was 1.5 +\\/- 0.16, and in the incontinent subjects it was 2.17 +\\/- 0.28 (p less than

M E Neill; M Swash

1980-01-01

233

Inhibition of Muscarinic-Stimulated Polyphosphoinositide Hydrolysis and Ca 2+ Mobilization in Cat Iris Sphincter Smooth Muscle Cells By cAMP-Elevating Agents  

Microsoft Academic Search

The effects of carbachol (CCh) on inositol 1,4,5-trisphosphate (IP3) production and intracellular calcium ([Ca2+]i) mobilization, and their regulation by cAMP-elevating agents were investigated in SV-40 transformed cat iris sphincter smooth muscle (SV-CISM-2) cells. CCh produced time- and dose-dependent increases in IP3 production; the t1\\/2 and EC50 values were 68 s and 0.5 ?M, respectively. The muscarinic agonist provoked a transient

Ke-Hong Ding; Shahid Husain; Rashid A Akhtar; Carlos M Isales; Ata A Abdel-Latif

1997-01-01

234

Tension-Free Vaginal Tape (TVT) in Stress Incontinent Women with Intrinsic Sphincter Deficiency (ISD) - A Long-Term Follow-up  

Microsoft Academic Search

In a prospective long-term study 49 women with stress incontinence and ISD (intrinsic sphincter deficiency) were followed for a mean of 4 years (range 3-5) after TVT operation. Preoperatively all patients underwent urodynamic investigations, quality of life evaluation, a 24-hour pad test and a gynecologic examination to properly verify the incontinence symptoms. The same protocol was used for postoperative evaluation.

M. Rezapour; C. Falconer; U. Ulmsten

2001-01-01

235

Comparison of the main body of the external anal sphincter muscle cross-sectional area between women with and without prolapse  

Microsoft Academic Search

The aim of the study was to compare the main body of the external anal sphincter (EAS) cross-sectional area (CSA) of women\\u000a with and without pelvic organ prolapse. Pelvic magnetic resonance imaging (MRI) scans of 40 women were selected for analysis.\\u000a Of these women, 20 had pelvic organ prolapse and 20 had normal support. Of the women with normal support,

Yvonne Hsu; Markus Huebner; Luyun Chen; Dee E. Fenner; John O. L. DeLancey

2007-01-01

236

Effects of Age, Gender, Bolus Condition, Viscosity, and Volume on Pharyngeal and Upper Esophageal Sphincter Pressure and Temporal Measurements during Swallowing  

ERIC Educational Resources Information Center

Purpose: The purpose of this study was to determine the effects of trial (i.e., Trial 1 vs. Trial 2); viscosity (i.e., saliva, thin, nectar-thick, honey-thick, and pudding-thick water); volume (i.e., 5 mL vs. 10 mL); age (i.e., young vs. older adults); and gender on pharyngeal (i.e., upper and lower) and upper esophageal sphincter (UES) pressures,…

Butler, Susan G.; Stuart, Andrew; Castell, Donald; Russell, Gregory B.; Koch, Kenneth; Kemp, Shannon

2009-01-01

237

Dosimetric Coverage of the External Anal Sphincter by 3-Dimensional Conformal Fields in Rectal Cancer Patients Receiving Neoadjuvant Chemoradiation: Implications for the Concept of Sphincter-Preserving Radiation Therapy  

PubMed Central

Background. We evaluated the anatomic location of the external anal sphincter (EAS) to pelvic bony landmarks related to 3-dimensional conformal radiotherapy (3DRT) and studied the dosimetric coverage of the EAS in patients undergoing neoadjuvant chemoradiation for rectal cancer. Methods. Sixty-four consecutive rectal cancer patients treated with neoadjuvant chemoradiation were included. All patients were treated in a prone position on a bellyboard by 3DRT. The inferior border of the RT fields was at least 3–5?cm inferior to the gross tumorous volume (GTV) or at the inferior border of the obturator foramen (IBOF), whichever was more inferior. The EAS was contoured and dose distributions were determined using dose-volume histograms. Results. In 53 out of 64 cases (82.8%), the EAS was completely inferior to the IBOF. In the remaining 11 cases, the EAS was either overlapping the IBOF (10 cases; 15.6%) or completely superior to the IBOF (1 case; 1.7%). The average mean dose delivered to the EAS was 2795?cGy. Lower mean doses were delivered to the EAS when the center of the EAS was located more distant from the GTV. Conclusions. Meticulous planning to define the inferior border of the RT field is recommended to avoid irradiating the EAS. PMID:25089274

Chen, Michelle B.; Liu, Alan J.; Tsai, Peter

2014-01-01

238

Long-term outcomes of urinary tract reconstruction in patients with neurogenic urinary tract dysfunction  

PubMed Central

The advent of specialized spinal units and better understanding of the pathophysiology of neurogenic urinary tract dysfunction has made long-term survival of these patients a reality. This has, in turn, led to an increase in quality and choice of management modalities offered to these patients including complex anatomic urinary tract reconstructive procedures tailored to the unique needs of each individual with variable outcomes. We performed a literature review evaluating the long-term outcomes of these reconstructive procedures. To achieve this, we conducted a world-wide electronic literature search of long-term outcomes published in English. As the premise of this review is long-term outcomes, we have focused on pathologies where evidence of long-term outcome is available such as patients with spinal injuries and spina bifida. Therapeutic success following urinary tract reconstruction is usually measured by preservation of renal function, improvement in quality-of-life, the satisfactory achievement of agreed outcomes and the prevention of serious complications. Prognostic factors include neuropathic detrusor overactivity; sphincter dyssynergia; bladder over distension; high pressure storage and high leak point pressures; vesicoureteric reflex, stone formation and urinary tract infections. Although, the past decade has witnessed a reduction in the total number of bladder reconstructive surgeries in the UK, these procedures are essentially safe and effective; but require long-term clinical and functional follow-up/monitoring. Until tissue engineering and gene therapy becomes more mainstream, we feel there is still a place for urinary tract reconstruction in patients with neurogenic lower urinary tract dysfunction. PMID:24235796

Johnson, E. U.; Singh, Gurpreet

2013-01-01

239

Location of the lower oesophageal sphincter and the squamous columnar mucosal junction in 109 healthy controls and 778 patients with different degrees of endoscopic oesophagitis.  

PubMed Central

In this study the location of the lower oesophageal sphincter measured by manometry and the location of the squamous columnar junction measured by endoscopy were determined in 109 healthy controls and 778 patients with different degrees of endoscopic oesophagitis. No significant differences in the prevalence and severity of the heartburn and regurgitation were observed when different degrees of oesophagitis were compared but dysphagia was more common and severe in patients with complicated Barrett's oesophagus (p < 0.001). This group also showed a male predominance and older age compared with other groups. The total length of the oesophagus, measured by the location of the distal end of the lower oesophageal sphincter was similar in all patients; however, the location of the squamous columnar junction extended more proximally and was related to the increasing severity of endoscopic oesophagitis. The manometric defects at the cardia were more frequent in severe oesophagitis (p < 0.001). These results suggest that, during the course of oesophagitis, the squamous columnar junction is displaced proximally. This displacement is limited to the mucosa, however, and does not involve the muscular layer, because the lower oesophageal sphincter undergoes no dislocation. PMID:8432446

Csendes, A; Maluenda, F; Braghetto, I; Csendes, P; Henriquez, A; Quesada, M S

1993-01-01

240

Male sexual dysfunction in Asia  

PubMed Central

Sex has always been a taboo subject in Asian society. However, over the past few years, awareness in the field of men's sexual health has improved, and interest in sexual health research has recently increased. The epidemiology and prevalence of erectile dysfunction, hypogonadism and premature ejaculation in Asia are similar in the West. However, several issues are specific to Asian males, including culture and beliefs, awareness, compliance and the availability of traditional/complementary medicine. In Asia, sexual medicine is still in its infancy, and a concerted effort from the government, relevant societies, physicians and the media is required to propel sexual medicine to the forefront of health care. PMID:21643001

Ho, Christopher CK; Singam, Praveen; Hong, Goh Eng; Zainuddin, Zulkifli Md

2011-01-01

241

Medical treatment of erectile dysfunction.  

PubMed Central

There has been a tremendous increase in demand for the treatment of erectile dysfunction in the last 10 years. This has occurred partly because of a greater understanding and awareness by both the general public and clinicians, and also because there now exists a range of effective treatments. The choice of treatments is increasing rapidly and novel delivery systems which may be more patient-friendly than intracavernosal injections are now becoming available. We review the published data on effectiveness and safety of the currently available treatments and discuss recent advances in oral therapy, as these drugs are likely to become available in the near future. Images Figure 1 Figure 2 PMID:9799886

Burns-Cox, N.; Gingell, C.

1998-01-01

242

Endothelial dysfunction: a comprehensive appraisal  

PubMed Central

The endothelium is a thin monocelular layer that covers all the inner surface of the blood vessels, separating the circulating blood from the tissues. It is not an inactive organ, quite the opposite. It works as a receptor-efector organ and responds to each physical or chemical stimulus with the release of the correct substance with which it may maintain vasomotor balance and vascular-tissue homeostasis. It has the property of producing, independently, both agonistic and antagonistic substances that help to keep homeostasis and its function is not only autocrine, but also paracrine and endocrine. In this way it modulates the vascular smooth muscle cells producing relaxation or contraction, and therefore vasodilatation or vasoconstriction. The endothelium regulating homeostasis by controlling the production of prothrombotic and antithrombotic components, and fibrynolitics and antifibrynolitics. Also intervenes in cell proliferation and migration, in leukocyte adhesion and activation and in immunological and inflammatory processes. Cardiovascular risk factors cause oxidative stress that alters the endothelial cells capacity and leads to the so called endothelial "dysfunction" reducing its capacity to maintain homeostasis and leads to the development of pathological inflammatory processes and vascular disease. There are different techniques to evaluate the endothelium functional capacity, that depend on the amount of NO produced and the vasodilatation effect. The percentage of vasodilatation with respect to the basal value represents the endothelial functional capacity. Taking into account that shear stress is one of the most important stimulants for the synthesis and release of NO, the non-invasive technique most often used is the transient flow-modulate "endothelium-dependent" post-ischemic vasodilatation, performed on conductance arteries such as the brachial, radial or femoral arteries. This vasodilatation is compared with the vasodilatation produced by drugs that are NO donors, such as nitroglycerine, called "endothelium independent". The vasodilatation is quantified by measuring the arterial diameter with high resolution ultrasonography. Laser-Doppler techniques are now starting to be used that also consider tissue perfusion. There is so much proof about endothelial dysfunction that it is reasonable to believe that there is diagnostic and prognostic value in its evaluation for the late outcome. There is no doubt that endothelial dysfunction contributes to the initiation and progression of atherosclerotic disease and could be considered an independent vascular risk factor. Although prolonged randomized clinical trials are needed for unequivocal evidence, the data already obtained allows the methods of evaluation of endothelial dysfunction to be considered useful in clinical practice and have overcome the experimental step, being non-invasive increases its value making it use full for follow-up of the progression of the disease and the effects of different treatments. PMID:16504104

Esper, Ricardo J; Nordaby, Roberto A; Vilariño, Jorge O; Paragano, Antonio; Cacharrón, José L; Machado, Rogelio A

2006-01-01

243

Down's Syndrome and Thyroid Dysfunction  

PubMed Central

A child with Down's syndrome (DS) and associated hyperthyroidism is described and studies pertinent to DS and thyroid function are discussed. A majority of data supports a hypothesis of immunological abnormalities in DS, with resultant thyroid dysfunction. It is puzzling that overt disease is not more common in DS, since the incidence of thyroid autoantibodies is high and autoimmunity and Hashimoto's thyroiditis are often associated with clinical thyroid disease. A physician who cares for children should consider thyroid disease in any child with DS who manifests a single compatible symptom. Palpation of the thyroid gland is essential during each physical examination. ImagesFigure 1 PMID:151752

Morton, Darryl A.; Jenkins, Melvin E.

1978-01-01

244

DNA Damage Foci at Dysfunctional Telomeres  

Microsoft Academic Search

We report cytologic and genetic data indicating that telomere dysfunction induces a DNA damage response in mammalian cells. Dysfunctional, uncapped telomeres, created through inhibition of TRF2, became associated with DNA damage response factors, such as 53BP1, ?-H2AX, Rad17, ATM, and Mre11. We refer to the domain of telomere-associated DNA damage factors as a Telomere Dysfunction-Induced Focus (TIF). The accumulation of

Hiroyuki Takai; Agata Smogorzewska; Titia de Lange

2003-01-01

245

Diabetes and sexual dysfunction: current perspectives  

PubMed Central

Diabetes mellitus is one of the most common chronic diseases in nearly all countries. It has been associated with sexual dysfunction, both in males and in females. Diabetes is an established risk factor for sexual dysfunction in men, as a threefold increased risk of erectile dysfunction was documented in diabetic men, as compared with nondiabetic men. Among women, evidence regarding the association between diabetes and sexual dysfunction are less conclusive, although most studies have reported a higher prevalence of female sexual dysfunction in diabetic women as compared with nondiabetic women. Female sexual function appears to be more related to social and psychological components than to the physiological consequence of diabetes. Hyperglycemia, which is a main determinant of vascular and microvascular diabetic complications, may participate in the pathogenetic mechanisms of sexual dysfunction in diabetes. Moreover, diabetic people may present several clinical conditions, including hypertension, overweight and obesity, metabolic syndrome, cigarette smoking, and atherogenic dyslipidemia, which are themselves risk factors for sexual dysfunction, both in men and in women. The adoption of healthy lifestyles may reduce insulin resistance, endothelial dysfunction, and oxidative stress – all of which are desirable achievements in diabetic patients. Improved well-being may further contribute to reduce and prevent sexual dysfunction in both sexes. PMID:24623985

Maiorino, Maria Ida; Bellastella, Giuseppe; Esposito, Katherine

2014-01-01

246

Magnetic sphincter augmentation with the LINX device for gastroesophageal reflux disease after U.S. Food and Drug Administration approval.  

PubMed

Magnetic sphincter augmentation (MSA) of the gastroesophageal junction with the LINX Reflux Management System is an alternative to fundoplication for gastroesophageal reflux disease (GERD) that was approved by the U.S. Food and Drug Administration (FDA) in March 2012. This is a prospective observational study of all patients who underwent placement of the LINX at two institutions from April 2012 to December 2013 to evaluate our clinical experience with the LINX device after FDA approval. There were no intraoperative complications and only four mild postoperative morbidities: three urinary retentions and one readmission for dehydration. The mean operative time was 60 minutes (range, 31 to 159 minutes) and mean length of stay was 11 hours (range, 5 to 35 hours). GERD health-related quality-of-life scores were available for 83 per cent of patients with a median follow-up of five months (range, 3 to 14 months) and a median score of four (range, 0 to 26). A total of 76.9 per cent of patients were no longer taking proton pump inhibitors. The most common postoperative complaint was dysphagia, which resolved in 79.1 per cent of patients with a median time to resolution of eight weeks. There were eight patients with persistent dysphagia that required balloon dilation with improvement in symptoms. MSA with LINX is a safe and effective alternative to fundoplication for treatment of GERD. The most common postoperative complaint is mild to moderate dysphagia, which usually resolves within 12 weeks. PMID:25264655

Reynolds, Jessica L; Zehetner, Joerg; Bildzukewicz, Nikolai; Katkhouda, Namir; Dandekar, Giovanni; Lipham, John C

2014-10-01

247

Sphincter sparing resection of a large obstructive distal rectal gastrointestinal stromal tumour after neoadjuvant therapy with imatinib (Glivec).  

PubMed

Gastrointestinal stromal tumours (GISTs) are generally rare but are known to be the most common mesenchymal tumours of the gastrointestinal tract. We present a case of a patient who presented with persistent obstructive gastrointestinal and urological symptoms, a sense of incomplete evacuation and bleeding per rectum. A colonoscopy was performed and a biopsy was taken of a submucosal mass in the distal rectum that revealed a GIST with positive KIT immunostaining. A positron emission tomography (PET)/CT scan showed a large metabolically active distal rectal tumour of 8?cm with macroscopic invasion of surrounding structures. Neoadjuvant therapy with receptor tyrosine kinase inhibitor imatinib (400?mg orally daily) was initiated and an excellent partial response consisting of a significant decrease in the size of the tumour with complete metabolic resolution was observed within 3?months. Six months after initiation of the neoadjuvant therapy a rectum resection with manual side-to-end coloanal anastomosis was performed. Pathology showed a GIST of 5?cm located 0.1?cm from the distal section plane. Our case shows that in patients with a large invasive distal rectal GIST, neoadjuvant imatinib therapy can facilitate anal sphincter sparing surgery. PMID:25572603

Kramp, Kelvin Harvey; Omer, Mohab Galal; Schoffski, Patrick; d'Hoore, Andre

2015-01-01

248

Mitochondrial dysfunction in cancer chemoresistance.  

PubMed

Mitochondrial dysfunction has been associated with cancer development and progression. Recent evidences suggest that pathogenic mutations or depletion of the mitochondrial genome can contribute to development of chemoresistance in malignant tumors. In this review we will describe the current knowledge on the role of mitochondrial dysfunction in the development of chemoresistance in cancer. We will also discuss the significance of this research topic in the context of development of more effective, targeted therapeutic modalities and diagnostic strategies for cancer patients, with a particular focus on the potential use of PARP inhibitors in cancer patients displaying mitochondrial DNA mutations. We will discuss recent studies highlighting the importance of the cross-talk between the tumor microenvironment and mitochondrial functionality in determining selective response to certain chemotherapeutic drugs. Finally, owing to the similarities between cancer and yeast cell metabolism, we will point out the use of yeast as a model system to study cancer-related genes and for anti-cancer drugs screening. PMID:25107705

Guaragnella, Nicoletta; Giannattasio, Sergio; Moro, Loredana

2014-11-01

249

[Coronary microvascular dysfunction. An update].  

PubMed

Several studies in the last years have shown that a dysfunction of coronary microcirculation may be responsible for abnormalities in coronary blood flow and some clinical pictures. Coronary microvascular dysfunction, in absence of other coronary artery abnormalities, can cause anginal symptoms, resulting in a condition named microvascular angina (MVA). MVA can occur in a chronic form, predominantly related to effort (stable MVA), more frequently referred as cardiac syndrome X, or in an acute form, most frequently ensuing at rest, which simulates an acute coronary syndrome (unstable MVA). The main abnormalities characterizing these two forms of MVA consist of an impaired vasodilation and an increased vasoconstriction of small resistive coronary arteries, respectively. The mechanisms responsible for stable MVA are still unclear, but seem to include, together with the known traditional cardiovascular risk factors, an abnormally increased cardiac adrenergic activity. The prognosis of stable MVA is good, but some patients have progressive worsening of symptoms. Clinical outcome of patients with unstable MVA is substantially unknown, as there are no specific studies about this population. Treatment of stable MVA includes traditional anti-ischemic drugs as first step; in case of persisting symptoms several other drugs have been proposed, including xanthine derivatives, ACE-inhibitors, statins and, in women, estrogens. Severe forms of intense constriction (or spasm) of small coronary arteries may cause transmural myocardial ischemia, as the microvascular form of variant angina and the tako-tsubo syndrome. PMID:21947187

Lamendola, Priscilla; Di Franco, Antonino; Tarzia, Pierpaolo; Milo, Maria; Laurito, Marianna; Lanza, Gaetano A

2011-09-01

250

Dysfunctional voiding syndromes and vesicoureteral reflux  

Microsoft Academic Search

Micturition disorders simulating neurogenic bladder disease have been loosely termed “dysfunctional voiding”. No underlying neuropathy can be found. A variety of voiding disturbances have been identified since the early 1970s, each with its own characteristics and clinical relevance. We have classified voiding dysfunctions into mild, moderate and severe, according to their potential impact on the upper tracts. Bladder instability, the

Yves L. Homsy

1994-01-01

251

Computational tools in rehabilitation of erectile dysfunction  

Microsoft Academic Search

Erectile dysfunction (ED) is defined as the inability to achieve and maintain an erection adequate for satisfactory intercourse. It is a common problem among approximately 50% of men between the ages of 40 and 70. Erectile dysfunction is not only stressful to both the affected individual and his partner, but it can also negatively affect self-esteem. Biomechanical models have recently

A. Gefen; J. Chen; D. Elad

2001-01-01

252

Towards an Analysis of Dysfunctional Grammar  

ERIC Educational Resources Information Center

This article applies Systemic Functional Linguistics (SFL) to the study of language dysfunction. It demonstrates the potential that Systemic Functional analysis can offer to one aspect of the analysis of language dysfunction--the failure to realise complexes of clauses. For the purpose of analysis, new concepts and new measures have been created.…

Rigaudeau-McKenna, B.

2005-01-01

253

Dysfunctional attention in autistic savants.  

PubMed

A dysfunctional attention hypothesis of the basis of savant skills was tested with a series of computerized tasks that assessed the ability to divide, shift, direct, and sustain attention. Ten healthy men with pervasive developmental disorders and unusual calendar-calculating skill, and 10 age- and sex-matched controls were tested. There were four general findings. First, the savants and controls did not differ on a measure of visual sustained attention. Second, the savants failed to detect rare auditory targets significantly more than did the controls. Third, the savants were unable to efficiently divide their attention when required to detect both visual and auditory targets simultaneously. Finally, deficient orienting or a deficit in shifting selective attention from one stimulus location to another was evidenced in overall slower reaction times for the savants across tasks requiring shifts and redirecting of attention. This deficit was attributed to an inability to disengage attention as a result of deficient orienting and overselectivity. PMID:8120129

Casey, B J; Gordon, C T; Mannheim, G B; Rumsey, J M

1993-11-01

254

Diabetes and Retinal Vascular Dysfunction  

PubMed Central

Diabetes predominantly affects the microvascular circulation of the retina resulting in a range of structural changes unique to this tissue. These changes ultimately lead to altered permeability, hyperproliferation of endothelial cells and edema, and abnormal vascularization of the retina with resulting loss of vision. Enhanced production of inflammatory mediators and oxidative stress are primary insults with significant contribution to the pathogenesis of diabetic retinopathy (DR). We have determined the identity of the retinal vascular cells affected by hyperglycemia, and have delineated the cell autonomous impact of high glucose on function of these cells. We discuss some of the high glucose specific changes in retinal vascular cells and their contribution to retinal vascular dysfunction. This knowledge provides novel insight into the molecular and cellular defects contributing to the development and progression of diabetic retinopathy, and will aid in the development of innovative, as well as target specific therapeutic approaches for prevention and treatment of DR.

Shin, Eui Seok; Sorenson, Christine M.; Sheibani, Nader

2014-01-01

255

Hypoparathyroidism presenting as cognitive dysfunction.  

PubMed

Metabolic dysfunction in hypoparathyroidism is an important cause of intracranial calcifications, which cause cognitive impairment depending on the calcified areas leading to difficulties in executing activities of daily living. We report a case of a 25-year-old man who presented with gradually decreasing organisational skills, memory problems and difficulty in carrying out daily activities. CT imaging of the brain showed extensive calcification in the basal ganglia and cerebral white matter. Comprehensive health-related quality of life and cognitive assessment revealed significant affliction in his activities of daily living along with impairment in recall memory, executive functions and verbal fluency. Owing to late diagnosis, chronicity of cognitive problems could not prevent him from discontinuing his college education. PMID:23709145

Kumar, Gunjan; Kaur, Darshpreet; Aggarwal, Puneet; Khurana, Tilak

2013-01-01

256

Balance Dysfunction in Parkinson's Disease  

PubMed Central

Stability and mobility in functional motor activities depend on a precise regulation of phasic and tonic muscular activity that is carried out automatically, without conscious awareness. The sensorimotor control of posture involves a complex integration of multisensory inputs that results in a final motor adjustment process. All or some of the components of this system may be dysfunctional in Parkinsonian patients, rendering postural instability one of the most disabling features of Parkinson's disease (PD). Balance control is critical for moving safely in and adapting to the environment. PD induces a multilevel impairment of this function, therefore worsening the patients' physical and psychosocial disability. In this review, we describe the complex ways in which PD impairs posture and balance, collecting and reviewing the available experimental evidence. PMID:25654100

Rinalduzzi, Steno; Missori, Paolo; Fattapposta, Francesco; Currà, Antonio

2015-01-01

257

Mitochondrial dysfunction affecting visual pathways.  

PubMed

Mitochondrial dysfunction leads to cellular energetic impairment, which may affect the visual pathways, from the retina to retrochiasmal structures. The most common mitochondrial optic neuropathies include Leber's hereditary optic neuropathy and autosomal dominant optic atrophy, but the optic nerve can be affected in other syndromic conditions, such as Wolfram syndrome and Friedreich's ataxia. These disorders may result from mutations in either the mitochondrial DNA or in the nuclear genes encoding mitochondrial proteins. Despite the inconstant genotype-phenotype correlations, a clinical classification of mitochondrial disorders may be made on the basis of distinct neuro-ophthalmic presentations such as optic neuropathy, pigmentary retinopathy and retrochiasmal visual loss. Although no curative treatments are available at present, recent advances throw new light on the pathophysiology of mitochondrial disorders. Current research raises hopes for novel treatment of hereditary optic neuropathies, particularly through the use of new drugs and mitochondrial gene therapy. PMID:24798923

Leruez, S; Amati-Bonneau, P; Verny, C; Reynier, P; Procaccio, V; Bonneau, D; Milea, D

2014-05-01

258

Animal models of erectile dysfunction  

PubMed Central

Animal models have contributed to a great extent to understanding and advancement in the field of sexual medicine. Many current medical and surgical therapies in sexual medicine have been tried based on these animal models. Extensive literature search revealed that the compiled information is limited. In this review, we describe various experimental models of erectile dysfunction (ED) encompassing their procedures, variables of assessment, advantages and disadvantages. The search strategy consisted of review of PubMed based articles. We included original research work and certain review articles available in PubMed database. The search terms used were “ED and experimental models,” “ED and nervous stimulation,” “ED and cavernous nerve stimulation,” “ED and central stimulation,” “ED and diabetes mellitus,” “ED and ageing,” “ED and hypercholesteremia,” “ED and Peyronie's disease,” “radiation induced ED,” “telemetric recording,” “ED and mating test” and “ED and non-contact erection test.”

Gajbhiye, Snehlata V.; Jadhav, Kshitij S.; Marathe, Padmaja A.; Pawar, Dattatray B.

2015-01-01

259

Mental dysfunction in Parkinson's disease.  

PubMed

The pathological hallmark of Parkinson's disease (PD) is a degeneration of the dopamine (DA) producing cells in the substantia nigra and the ventral tegmentum, resulting in a dopamine deficiency in the dopaminergic projection areas with defective functioning of specific cortico-subcortical extrapyramidal circuits. Depending on which circuits (;motor', ;association' or ;limbic') are involved, and on the extent of the accompanying noradrenergic, serotonergic and cholinergic detrition in PD, dysfunction may result in motor deficits, mood disturbances or cognitive deficits, sometimes proceeding to dementia. Drug-induced psychosis occurs in approximately 15-20% of patients treated with dopaminergic agents. In PD, mainly nigrostriatal dopamine (A9) is depleted, leading to progressive motor dysfunction with subtle cognitive disturbances. As a rule, the neuropsychological deficit in PD might be described as the inability to switch cortical behavioral programmes in situations requiring the internal regulation of behavior. In daily life, in most patients these deficits do not become manifest, due to the abundance of external information to guide behavior. When the ability to use environmental information or external cues is lost as well, significant cell loss in the ventral tegmental area, with reduced DA-innervation of the mesocorticolimbic regions and the nucleus accumbens, must be suspected. This leads to clinically overt defects not only in the ;motor' but also in the ;limbic' and ;association' circuits. In addition to more severe cognitive disturbances or even dementia, this may also lead to mood disorders and drug-induced psychosis. Depression then occurs as the cortical modulation of limbic activity has become deficient, leading to emotional reactions disproportionate to the thoughts that evoke them. The proposed mechanism of psychosis in PD is that cortical sensory input is misinterpreted, leading to misperceptions (hallucinations) or false beliefs about reality due to a reduced ;signal-to-noise' ratio by insufficient processing of relevant information. PMID:18591098

Wolters, E C; Francot, C M

1998-10-01

260

Lack of awareness of erectile dysfunction in many men with risk factors for erectile dysfunction  

PubMed Central

Background Men with erectile dysfunction often have concurrent medical conditions. Conversely, men with these conditions may also have underlying erectile dysfunction. The prevalence of unrecognized erectile dysfunction in men with comorbidities commonly associated with erectile dysfunction was determined in men invited to participate in a double-blind, randomized, placebo-controlled trial of sildenafil citrate. Methods Men ?30 years old presenting with ?1 erectile dysfunction risk factor (controlled hypertension, hypercholesterolemia, smoking, metabolic syndrome, stable coronary artery disease, diabetes, depression, lower urinary tract symptoms, obesity [body mass index ?30 kg/m2] or waist circumference ?40 inches), and not previously diagnosed with erectile dysfunction were evaluated. The screening question, "Do you have erectile dysfunction?," with responses of "no," "yes," and "unsure," and the Erectile Function domain of the International Index of Erectile Function (IIEF-EF) were administered. Results Of 1084 men screened, 1053 answered the screening question and also had IIEF-EF scores. IIEF-EF scores indicating erectile dysfunction occurred in 71% (744/1053), of whom 54% (399/744) had moderate or severe erectile dysfunction. Of 139 answering "yes," 526 answering "unsure," and 388 answering "no," 96%, 90%, and 36%, respectively, had some degree of erectile dysfunction. The mean±SD (range) number of risk factors was 2.9 ± 1.7 (3-8) in the "yes" group, 3.2 ± 1.7 (3-9) in the "unsure" group, and 2.6 ± 1.5 (2-8) in the "no" group. Conclusion Although awareness of having erectile dysfunction was low, most men with risk factors had IIEF-EF scores indicating erectile dysfunction. Erectile dysfunction should be suspected and assessed in men with risk factors, regardless of their apparent level of awareness of erectile dysfunction. Trial registration ClinicalTrials.gov Identifier NCT00343200. PMID:21054874

2010-01-01

261

Role of Lipotoxicity in Endothelial Dysfunction  

PubMed Central

SUMMARY Lipotoxicity, caused in large part by overnutrition, directly leads to endothelial dysfunction. Excess lipids in both the circulation and at the tissue level contribute to endothelial dysfunction that underlies much of the pathophysiology of both metabolic disease, including obesity and diabetes and their CV complications. Direct lipotoxic effects on other organs as well as secondary insults from endothelial dysfunction synergize to cause substantial morbidity and mortality. Lifestyle interventions, including reduced calorie intake, diet, and exercise as well as a variety of pharmacologic interventions targeting various mechanisms underlying lipotoxicity in vascular endothelium significantly modify metabolic and CV risk. PMID:22999242

Kim, Jeong-a; Montagnani, Monica; Chandrasekran, Sruti; Quon, Michael J.

2014-01-01

262

[Sexual dysfunction associated with antidepressant agents.  

PubMed

Sexual dysfunction is a common adverse effect of antidepressant treatment and a main reason for non-compliance with treatment. Different antidepressant agents are associated with different degrees of dysfunction, which is thought to depend on the agent's pharmacological profile. Agents with serotonergic activity, such as selective serotonin reuptake inhibitors (SSRI) and venlafaxine, yield the highest rate of sexual dysfunction. Non-SSRI agents such as duloxetine, reboxetine and mirtazapine have fewer sexual side effects than SSRI and venlafaxine. Agomelatine and bupropion are similar to placebo. PMID:25352006

Bergh, Sara Johanna; Giraldi, Annamaria

2014-05-26

263

Metabolic Dysfunction in Diabetic Cardiomyopathy  

PubMed Central

Diabetic cardiomyopathy (DCM) is defined as cardiac disease independent of vascular complications during diabetes. The number of new cases of DCM is rising at epidemic rates in proportion to newly diagnosed cases of diabetes mellitus (DM) throughout the world. DCM is a heart failure syndrome found in diabetic patients that is characterized by left ventricular hypertrophy and reduced diastolic function, with or without concurrent systolic dysfunction, occurring in the absence of hypertension and coronary artery disease. DCM and other diabetic complications are caused in part by elevations in blood glucose and lipids, characteristic of DM. Although there are pathological consequences to hyperglycemia and hyperlipidemia, the combination of the two metabolic abnormalities potentiates the severity of diabetic complications. A natural competition exists between glucose and fatty acid metabolism in the heart that is regulated by allosteric and feedback control and transcriptional modulation of key limiting enzymes. Inhibition of these glycolytic enzymes not only controls flux of substrate through the glycolytic pathway, but also leads to the diversion of glycolytic intermediate substrate through pathological pathways, which mediate the onset of diabetic complications. The present review describes the limiting steps involved in the development of these pathological pathways and the factors involved in the regulation of these limiting steps. Additionally, therapeutic options with demonstrated or postulated effects on DCM are described. PMID:23443849

Isfort, Michael; Stevens, Sarah C.W.; Schaffer, Stephen; Jong, Chian Ju; Wold, Loren E.

2013-01-01

264

Neurostimulation for Neurogenic Bowel Dysfunction  

PubMed Central

Background. Loss of normal bowel function caused by nerve injury, neurological disease or congenital defects of the nervous system is termed neurogenic bowel dysfunction (NBD). It usually includes combinations of fecal incontinence, constipation, abdominal pain and bloating. When standard treatment of NBD fails surgical procedures are often needed. Neurostimulation has also been investigated, but no consensus exists about efficacy or clinical use. Methods. A systematic literature search of NBD treated by sacral anterior root stimulation (SARS), sacral nerve stimulation (SNS), peripheral nerve stimulation, magnetic stimulation, and nerve re-routing was made in Pubmed, Embase, Scopus, and the Cochrane Library. Results. SARS improves bowel function in some patients with complete spinal cord injury (SCI). Nerve re-routing is claimed to facilitate defecation through mechanical stimulation of dermatomes in patients with complete or incomplete SCI or myelomeningocele. SNS can reduce NBD in selected patients with a variety of incomplete neurological lesions. Peripheral stimulation using electrical stimulation or magnetic stimulation may represent non-invasive alternatives. Conclusion. Numerous methods of neurostimulation to treat NBD have been investigated in pilot studies or retrospective studies. Therefore, larger controlled trials with well-defined inclusion criteria and endpoints are recommended before widespread clinical use of neurostimulation against NBD. PMID:23573076

Worsøe, J.; Rasmussen, M.; Christensen, P.; Krogh, K.

2013-01-01

265

Amiodarone-related thyroid dysfunction.  

PubMed

Nowadays, amiodarone is the most commonly used antidysrhythmic drug in clinical practice. It is highly effective in the management of recurrent ventricular dysrhythmias, paroxysmal supraventricular dysrhythmias, including atrial fibrillation and flutter, and in the maintenance of sinus rhythm after electrical cardioversion of atrial fibrillation. Moreover, it has the added benefit of being well tolerated in patients with both normal and impaired left ventricular systolic function. Despite amiodarone's potent antidysrhythmic actions, its use is hampered by numerous adverse effects on various organs, including the thyroid. Adverse effects are becoming more prevalent given the increasing incidence of dysrhythmias and wider amiodarone use. Thus, physicians and patients should both be aware of the potential thyroid-specific sequelae. However, amiodarone is likely to remain a significant problem for endocrinologists as concerns exist over the use of the new alternative antiarrhythmic agent, dronedarone, especially in patients with heart failure and left ventricular dysfunction because of the risk of hepatic injury and increased mortality. The final diagnostic and therapeutic approaches must be discussed among the patient, the general practitioner, the cardiologist, and the endocrinologist. PMID:25348560

Hudzik, Bartosz; Zubelewicz-Szkodzinska, Barbara

2014-12-01

266

Flibanserin for female sexual dysfunction.  

PubMed

Hypoactive sexual desire disorder (HSDD) is the most commonly described form of female sexual dysfunction. There is currently no pharmacological therapy approved to treat HSDD, and therefore, there is an unmet medical need for the development of efficacious treatment alternatives. Flibanserin is a novel, non-hormonal drug for the treatment of HSDD in pre- and postmenopausal women, although the application submitted to the U.S. Food and Drug Administration by Sprout Pharmaceuticals is only for premenopausal women. Flibanserin works by correcting an imbalance of the levels of the neurotransmitters that affect sexual desire. More specifically, flibanserin increases dopamine and norepinephrine, both responsible for sexual excitement, and decreases serotonin, responsible for sexual inhibition. Clinically, flibanserin has exhibited some encouraging results in terms of its ability to increase the frequency of satisfying sexual events, and the intensity of sexual desire. However, adverse events such as dizziness, nausea, fatigue and somnolence, typical of a centrally acting drug, are also frequently related to flibanserin treatment. PMID:25187905

Reviriego, C

2014-08-01

267

JAMA Patient Page: Male Sexual Dysfunction  

MedlinePLUS

... share with patients. Any other print or online reproduction is subject to AMA approval. To purchase bulk reprints, call 718/946-7424. • Low libido (sexual interest) • Erectile dysfunction (ED, difficulty achieving or maintaining ...

268

Meibomian Gland Dysfunction and Treatment (Posterior Blepharitis)  

MedlinePLUS

... Meibomian Gland Dysfunction and Treatment What are Meibomian (Oil) Glands? Meibomian glands are glands that are arranged ... lashes. The force of an eyelid blink causes oil to be excreted onto the posterior lid margin. ...

269

Treatment of sleep dysfunction and psychiatric disorders  

Microsoft Academic Search

Opinion statement  Patients with neurologic disorders commonly experience sleep dysfunction and psychiatric disorders. The most common sleep\\u000a dysfunction is insomnia, which is a primary symptom in 30% to 90% of psychiatric disorders. Insomnia and fatigue are prominent\\u000a symptoms of anxiety disorders and major depression, including patients who are treated but have residual symptoms. Anxiety\\u000a and depressive disorders account for 40% to

Philip M. Becker

2006-01-01

270

Sexual dysfunction among patients with arthritis  

Microsoft Academic Search

Summary  The relationship of arthritis and sexual dysfunction was investigated among 169 patients with rheumatoid arthritis, osteoarthritis and spondyloarthropathy, 130 of whom were pair-matched to controls. Assessments of marital happiness and depressed mood were also made using the CES-D and the Azrin Marital Happiness Scale (AMHS). Sexual dysfunctions were found to be common among patients and controls, the majority in both

D. J. Blake; R. Maisiak; A. Koplan; G. S. Alarcón; S. Brown

1988-01-01

271

Sexual dysfunction in the medically ill  

Microsoft Academic Search

Common in the medically ill, sexual dysfunction results from disruption of one or more stages of the sexual response cycle.\\u000a Increased understanding of sexual pathophysiology and the psychosocial forces whereby diseases impede normal function promotes\\u000a more informed treatment choices. This review focuses on the pathophysiology, impact, and treatment options of sexual dysfunction\\u000a in men and women with spinal cord injuries,

Kristin J. Somers; Kemuel L. Philbrick

2007-01-01

272

Sinus node dysfunction complicating viper bite.  

PubMed

Viper venom toxicities comprise mainly bleeding disorders and nephrotoxicity. Cardiotoxicity is a rare manifestation of viper bite. We describe the case of a previously healthy 35-year-old man who developed coagulopathy and sinus node dysfunction following a viper bite. Electrocardiography showed sinus arrest and junctional escape rhythm. This is the first account of sinus node dysfunction caused by a viper bite. PMID:24887872

Agarwal, Ashish; Kumar, Tarun; Ravindranath, Khandenahally S; Bhat, Prabhavathi; Manjunath, Cholenahally N; Agarwal, Neena

2015-02-01

273

Current concepts in voiding dysfunction and dysfunctional voiding: A review from a urogynaecologist's perspective  

PubMed Central

Background: Female voiding dysfunction is a complex disorder, lacks definition, and is poorly understood and difficult to manage. Causes of Female Voiding Dysfunction: As there is no agreed classification of female voiding dysfunction, it is important to identify the several potential factors that might cause voiding dysfunction, namely anatomic, neurogenic, pharmacologic, endocrine, pharmacological and other causes. Presentation and Clinical Evaluation: Traditional and novel techniques are available and the importance and diagnostic dilemma related to these conditions need to be understood. We conclude by emphasizing the need to simplify the diagnosis and nomenclature of these conditions from a more clinical point of view as against an investigational perspective. PMID:25316994

Karmakar, Debjyoti; Sharma, Jai B

2014-01-01

274

Posterior tibial tendon dysfunction: a review.  

PubMed

Posterior tibial tendon dysfunction is a progressive deformity that can result in the development of a pathologic flatfoot deformity. Numerous publications have studied the effects of clinical interventions at specific stages of progression of posterior tibial tendon dysfunction, but there is still uncertainty regarding the clinical identification of the condition. It is clear that more information regarding the etiology, progression, and risk factors of posterior tibial tendon dysfunction is required. Clear evidence exists that suggests that the quality of life for patients with posterior tibial tendon dysfunction is significantly affected. Furthermore, evidence suggests that early conservative intervention can significantly improve quality of life regarding disability, function, and pain. This would suggest that significant cost burden reductions could be made by improving awareness of the condition, which would improve early diagnosis. Early conservative intervention may help reduce the number of patients requiring surgery. This review focuses on the etiologic factors, epidemiologic features, and pathogenesis of posterior tibial tendon dysfunction. It aims to analyze, discuss, and debate the current understanding of this condition using the available literature. In addition, there is a discussion of the evidence base surrounding disease characteristics associated with the different clinical stages of posterior tibial tendon dysfunction. PMID:21406702

Durrant, Beverley; Chockalingam, Nachiappan; Hashmi, Farina

2011-01-01

275

Localization and activity of haem oxygenase and functional effects of carbon monoxide in the feline lower oesophageal sphincter.  

PubMed Central

1. In the feline lower oesophageal sphincter (LOS), the distribution of the carbon monoxide (CO) producing enzymes haem oxygenase (HO)-1 and -2 was studied by immunohistochemistry and confocal microscopy, the HO activity was measured and the possible role for CO as a mediator of relaxation was investigated. 2. HO-2 immunoreactivity was abundant in nerve cell bodies of the submucosal and myenteric plexus. Approximately 50% of the HO-2-containing myenteric cell bodies were also nitric oxide synthase- and vasoactive intestinal peptide (VIP)-immunoreactive. In addition, HO-2 immunoreactivity was seen in nerve fibres, in non-neuronal cells dispersed in the smooth muscle and in arterial endothelium. HO-1 immunoreactivity was confined to non-neuronal cells in the smooth muscle, similar to those positive for HO-2. 3. Activity of HO, measured as CO production, was observed in LOS homogenates at a rate of 1.00 +/- 0.05 nmol mg-1 protein h-1. This production was inhibited by the HO inhibitor, zinc protoporphyrin-IX (ZnPP). 4. In isolated circular smooth muscle strips of LOS, developing spontaneous tone, exogenously administered CO evoked a concentration-dependent relaxation reaching a maximum of 93 +/- 3%. This relaxation was accompanied by an increase in cyclic GMP, but not cyclic AMP levels. The relaxant response was attenuated by methylene blue, but unaffected by tetrodotoxin. Repeated exposure to CO resulted in a progressive reduction of the relaxant response. 5. ZnPP caused a rightward-shift of the concentration-response curves for the relaxant responses to VIP, peptide histidine isoleucine, and pituitary adenylate cyclase activating peptide 27. 6. ZnPP and tin protoporphyrin-IX (another inhibitor of HO) did not affect nonadrenergic, noncholinergic relaxations induced by electrical field stimulation. Nor did ZnPP affect relaxations induced by 3-morpholino-sydnonimine or forskolin. 7. The present findings, showing localization of HO immunoreactivity to both neuronal and nonneuronal cells of the feline LOS, ability of LOS to produce CO and a relaxant effect of CO in circular LOS muscle, suggest a role for CO as a peripheral messenger. Images Figure 1 PMID:8735643

Ny, L.; Alm, P.; Ekström, P.; Larsson, B.; Grundemar, L.; Andersson, K. E.

1996-01-01

276

Cognitive dysfunction in mitochondrial disorders.  

PubMed

Among the various central nervous system (CNS) manifestations of mitochondrial disorders (MIDs), cognitive impairment is increasingly recognized and diagnosed (mitochondrial cognitive dysfunction). Aim of the review was to summarize recent findings concerning the aetiology, pathogenesis, diagnosis and treatment of cognitive decline in MIDs. Among syndromic MIDs due to mitochondrial DNA (mtDNA) mutations, cognitive impairment occurs in patients with mitochondrial encephalopathy, lactic acidosis and stroke-like episodes syndrome, myoclonus epilepsy with ragged-red fibres syndrome, mitochondrial chronic progressive external ophthalmoplegia, Kearns-Sayre syndrome, neuropathy, ataxia and retinitis pigmentosa syndrome and maternally inherited diabetes and deafness. Among syndromic MIDs due to nuclear DNA (nDNA) mutations, cognitive decline has been reported in myo-neuro-gastro-intestinal encephalopathy, mitochondrial recessive ataxia syndrome, spinocerebellar ataxia with encephalopathy, Mohr-Tranebjaerg syndrome, leuko-encephalopathy; brain and spinal cord involvement and lactic acidosis, CMT2, Wolfram syndrome, Wolf-Hirschhorn syndrome and Leigh syndrome. In addition to syndromic MIDs, a large number of non-syndromic MIDs due to mtDNA as well as nDNA mutations have been reported, which present with cognitive impairment as the sole or one among several other CNS manifestations of a MID. Delineation of mitochondrial cognitive impairment from other types of cognitive impairment is essential to guide the optimal management of these patients. Treatment of mitochondrial cognitive impairment is largely limited to symptomatic and supportive measures. Cognitive impairment may be a CNS manifestation of syndromic as well as non-syndromic MIDs. Correct diagnosis of mitochondrial cognitive impairment is a prerequisite for the optimal management of these patients. PMID:22335339

Finsterer, J

2012-07-01

277

Shockwave treatment of erectile dysfunction  

PubMed Central

Low-intensity extracorporeal shock wave therapy (LI-ESWT) is a novel modality that has recently been developed for treating erectile dysfunction (ED). Unlike other current treatment options for ED, all of which are palliative in nature, LI-ESWT is unique in that it aims to restore the erectile mechanism in order to enable natural or spontaneous erections. Results from basic science experiments have provided evidence that LI-ESWT induces cellular microtrauma, which in turn stimulates the release of angiogenic factors and the subsequent neovascularization of the treated tissue. Extracorporeal shock wave therapy (ESWT) has been clinically investigated and applied in several medical fields with various degrees of success. High-intensity shock wave therapy is used for lithotripsy because of its focused mechanical destructive nature, and medium-intensity shock waves have been shown to have anti-inflammatory properties and are used for treating a wide array of orthopedic conditions, such as non-union fractures, tendonitis, and bursitis. In contrast, LI-ESWT has angiogenetic properties and is therefore used in the management of chronic wounds, peripheral neuropathy, and in cardiac neovascularization. As a result of these characteristics we initiated a series of experiments evaluating the effect of LI-ESWT on the cavernosal tissue of patients with vasculogenic ED. The results of our studies, which also included a double-blind randomized control trial, confirm that LI-ESWT generates a significant clinical improvement of erectile function and a significant improvement in penile hemodynamics without any adverse effects. Although further extensive research is needed, LI-ESWT may create a new standard of care for men with vasculogenic ED. PMID:23554844

Appel, Boaz; Kitrey, Noam D.; Vardi, Yoram

2013-01-01

278

An analysis of survival and treatment failure following abdominoperineal and sphincter-saving resection in Dukes' B and C rectal carcinoma. A report of the NSABP clinical trials. National Surgical Adjuvant Breast and Bowel Project.  

PubMed Central

Abdominoperineal resections for rectal carcinoma are being performed with decreasing frequency in favor of sphincter-saving resections. It remains, however, to be unequivocally demonstrated that sphincter preservation has not resulted in compromised local disease control, disease-free survival, and survival. Accordingly, it is the specific aim of this endeavor to compare local recurrence, disease-free survival, and survival in patients with Dukes' B and C rectal cancer undergoing curative abdominoperineal resection or sphincter-saving resection. For the purpose of this study, 232 patients undergoing abdominoperineal resection and 181 subjected to sphincter-saving resections were available for analysis from an NSABP randomized prospective clinical trial designed to ascertain the efficacy of adjuvant therapy in rectal carcinoma (protocol R-01). The mean time on study was 48 months. Analyses were carried out comparing the two operations according to Dukes' class, the number of positive nodes, and tumor size. The only significant differences in disease-free survival and survival were observed for the cohort characterized by greater than 4 positive nodes and were in favor of patients treated with sphincter-saving resections. A patient undergoing sphincter-saving resection was 0.62 times as likely to sustain a treatment failure as a similar patient undergoing abdominoperineal resection (p = 0.07) and 0.49 times as likely to die (p = 0.02). The inability to demonstrate an attenuated disease-free survival and survival for patients treated with sphincter-saving resection was in spite of an increased incidence of local recurrence (anastomotic and pelvic) observed for the latter operation when compared to abdominoperineal resection (13% vs. 5%). A similar analysis evaluating the length of margins of resection in patients undergoing sphincter-preserving operations indicated that treatment failure and survival were not significantly different in patients whose distal resection margins were less than 2 cm, 2-2.9 cm, or greater than or equal to 3 cm. If any trend was observed, it appeared that patients with smaller resection margins had a slightly prolonged survival (p = 0.10). This observation was present in spite of the fact that local recurrence as a first site of treatment failure was greater in the group with less than 2 cm that it was in the greater than or equal to 3 cm category, 22% versus 12%. This increased local recurrence rate in the population with smaller margins was not translated into an in crease in overall treatment failure and had absolutely no influence on survival. It is suggested that local recurrence serves as a marker of distant disease.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:3532972

Wolmark, N; Fisher, B

1986-01-01

279

Quality of Life in the Late Follow-Up of Ulcerative Colitis Patients Submitted to Restorative Proctocolectomy with Sphincter Preservation Over Ten Years Ago  

PubMed Central

OBJECTIVE To evaluate, by means of the Inflammatory Bowel Disease Questionnaire (IBDQ), the quality of life of ulcerative colitis patients submitted to proctocolectomy with sphincter preservation using J-pouch reconstruction over ten years ago. METHODS The study consisted of 36 patients interviewed using the Inflammatory Bowel Disease Questionnaire. The score scale, resulting from the addition of each answer, ranged from 32 to 224, where the highest score indicates the best quality of life. The chi square test was used to verify the existence of meaningful differences between the results of the questionnaire and age, and gender proportion. For each section, as well as for all of them combined, the Kruskal-Wallis test was used to verify if there were differences in the Inflammatory Bowel Disease Questionnaire scores among the groups in relation to the proportions. RESULTS After applying the Inflammatory Bowel Disease Questionnaire, it was determined that quality of life was considered excellent for 9 (25%), good for 11 (30.6%), regular for 13 (36.1%), and bad for 3 (8.3%) patients. In our study, we determined that 85% of the patients were pleased with and thankful for the surgery that they underwent. CONCLUSION We can conclude that the possibility of sphincter preservation should always be taken into account, since patients remain clinically stable and have a high quality of life even after long periods. PMID:19759881

Meyer, Alberto Luiz Monteiro; Teixeira, Magaly Gêmeo; de Almeida, Maristela Gomes; Kiss, Desidério Roberto; Nahas, Sergio Carlos; Cecconello, Ivan

2009-01-01

280

Apraxia and Motor Dysfunction in Corticobasal Syndrome  

PubMed Central

Background Corticobasal syndrome (CBS) is characterized by multifaceted motor system dysfunction and cognitive disturbance; distinctive clinical features include limb apraxia and visuospatial dysfunction. Transcranial magnetic stimulation (TMS) has been used to study motor system dysfunction in CBS, but the relationship of TMS parameters to clinical features has not been studied. The present study explored several hypotheses; firstly, that limb apraxia may be partly due to visuospatial impairment in CBS. Secondly, that motor system dysfunction can be demonstrated in CBS, using threshold-tracking TMS, and is linked to limb apraxia. Finally, that atrophy of the primary motor cortex, studied using voxel-based morphometry analysis (VBM), is associated with motor system dysfunction and limb apraxia in CBS. Methods Imitation of meaningful and meaningless hand gestures was graded to assess limb apraxia, while cognitive performance was assessed using the Addenbrooke's Cognitive Examination – Revised (ACE-R), with particular emphasis placed on the visuospatial subtask. Patients underwent TMS, to assess cortical function, and VBM. Results In total, 17 patients with CBS (7 male, 10 female; mean age 64.4+/? 6.6 years) were studied and compared to 17 matched control subjects. Of the CBS patients, 23.5% had a relatively inexcitable motor cortex, with evidence of cortical dysfunction in the remaining 76.5% patients. Reduced resting motor threshold, and visuospatial performance, correlated with limb apraxia. Patients with a resting motor threshold <50% performed significantly worse on the visuospatial sub-task of the ACE-R than other CBS patients. Cortical function correlated with atrophy of the primary and pre-motor cortices, and the thalamus, while apraxia correlated with atrophy of the pre-motor and parietal cortices. Conclusions Cortical dysfunction appears to underlie the core clinical features of CBS, and is associated with atrophy of the primary motor and pre-motor cortices, as well as the thalamus, while apraxia correlates with pre-motor and parietal atrophy. PMID:24664085

Burrell, James R.; Hornberger, Michael; Vucic, Steve; Kiernan, Matthew C.; Hodges, John R.

2014-01-01

281

In Search of the Optimal Surgical Treatment for Velopharyngeal Dysfunction in 22q11.2 Deletion Syndrome: A Systematic Review  

PubMed Central

Background Patients with the 22q11.2 deletion syndrome (22qDS) and velopharyngeal dysfunction (VPD) tend to have residual VPD following surgery. This systematic review seeks to determine whether a particular surgical procedure results in superior speech outcome or less morbidity. Methodology/ Principal Findings A combined computerized and hand-search yielded 70 studies, of which 27 were deemed relevant for this review, reporting on a total of 525 patients with 22qDS and VPD undergoing surgery for VPD. All studies were levels 2c or 4 evidence. The methodological quality of these studies was assessed using criteria based on the Cochrane Collaboration's tool for assessing risk of bias. Heterogeneous groups of patients were reported on in the studies. The surgical procedure was often tailored to findings on preoperative imaging. Overall, 50% of patients attained normal resonance, 48% attained normal nasal emissions scores, and 83% had understandable speech postoperatively. However, 5% became hyponasal, 1% had obstructive sleep apnea (OSA), and 17% required further surgery. There were no significant differences in speech outcome between patients who underwent a fat injection, Furlow or intravelar veloplasty, pharyngeal flap pharyngoplasty, Honig pharyngoplasty, or sphincter pharyngoplasty or Hynes procedures. There was a trend that a lower percentage of patients attained normal resonance after a fat injection or palatoplasty than after the more obstructive pharyngoplasties (11–18% versus 44–62%, p?=?0.08). Only patients who underwent pharyngeal flaps or sphincter pharyngoplasties incurred OSA, yet this was not statistically significantly more often than after other procedures (p?=?0.25). More patients who underwent a palatoplasty needed further surgery than those who underwent a pharyngoplasty (50% versus 7–13%, p?=?0.03). Conclusions/ Significance In the heterogeneous group of patients with 22qDS and VPD, a grade C recommendation can be made to minimize the morbidity of further surgery by choosing to perform a pharyngoplasty directly instead of only a palatoplasty. PMID:22470558

Spruijt, Nicole E.; ReijmanHinze, Judith; Hens, Greet; Vander Poorten, Vincent; Mink van der Molen, Aebele B.

2012-01-01

282

Pulmonary vascular dysfunction in ARDS  

PubMed Central

Acute respiratory distress syndrome (ARDS) is characterised by diffuse alveolar damage and is frequently complicated by pulmonary hypertension (PH). Multiple factors may contribute to the development of PH in this setting. In this review, we report the results of a systematic search of the available peer-reviewed literature for papers that measured indices of pulmonary haemodynamics in patients with ARDS and reported on mortality in the period 1977 to 2010. There were marked differences between studies, with some reporting strong associations between elevated pulmonary arterial pressure or elevated pulmonary vascular resistance and mortality, whereas others found no such association. In order to discuss the potential reasons for these discrepancies, we review the physiological concepts underlying the measurement of pulmonary haemodynamics and highlight key differences between the concepts of resistance in the pulmonary and systemic circulations. We consider the factors that influence pulmonary arterial pressure, both in normal lungs and in the presence of ARDS, including the important effects of mechanical ventilation. Pulmonary arterial pressure, pulmonary vascular resistance and transpulmonary gradient (TPG) depend not alone on the intrinsic properties of the pulmonary vascular bed but are also strongly influenced by cardiac output, airway pressures and lung volumes. The great variability in management strategies within and between studies means that no unified analysis of these papers was possible. Uniquely, Bull et al. (Am J Respir Crit Care Med 182:1123–1128, 2010) have recently reported that elevated pulmonary vascular resistance (PVR) and TPG were independently associated with increased mortality in ARDS, in a large trial with protocol-defined management strategies and using lung-protective ventilation. We then considered the existing literature to determine whether the relationship between PVR/TPG and outcome might be causal. Although we could identify potential mechanisms for such a link, the existing evidence does not allow firm conclusions to be drawn. Nonetheless, abnormally elevated PVR/TPG may provide a useful index of disease severity and progression. Further studies are required to understand the role and importance of pulmonary vascular dysfunction in ARDS in the era of lung-protective ventilation.

2014-01-01

283

DNA damage foci at dysfunctional telomeres.  

PubMed

We report cytologic and genetic data indicating that telomere dysfunction induces a DNA damage response in mammalian cells. Dysfunctional, uncapped telomeres, created through inhibition of TRF2, became associated with DNA damage response factors, such as 53BP1, gamma-H2AX, Rad17, ATM, and Mre11. We refer to the domain of telomere-associated DNA damage factors as a Telomere Dysfunction-Induced Focus (TIF). The accumulation of 53BP1 on uncapped telomeres was reduced in the presence of the PI3 kinase inhibitors caffeine and wortmannin, which affect ATM, ATR, and DNA-PK. By contrast, Mre11 TIFs were resistant to caffeine, consistent with previous findings on the Mre11 response to ionizing radiation. A-T cells had a diminished 53BP1 TIF response, indicating that the ATM kinase is a major transducer of this pathway. However, in the absence of ATM, TRF2 inhibition still induced TIFs and senescence, pointing to a second ATM-independent pathway. We conclude that the cellular response to telomere dysfunction is governed by proteins that also control the DNA damage response. TIFs represent a new tool for evaluating telomere status in normal and malignant cells suspected of harboring dysfunctional telomeres. Furthermore, induction of TIFs through TRF2 inhibition provides an opportunity to study the DNA damage response within the context of well-defined, physically marked lesions. PMID:12956959

Takai, Hiroyuki; Smogorzewska, Agata; de Lange, Titia

2003-09-01

284

Sex therapy for female sexual dysfunction  

PubMed Central

Introduction About 45% of women suffer from some form of sexual dysfunction. Despite its high prevalence, there are few studies that have systematically evaluated sex therapy in comparison with other interventions. Objective Review randomized clinical trials that present psychotherapeutic interventions for female sexual dysfunctions. Method Through a search in three databases (Medline, Web of Science and PsycInfo), 1419 references were found. After an analysis of the abstracts, twenty-seven articles met the inclusion criteria and composed this review. Results Sex therapy, as proposed by Masters and Johnson and Heiman and LoPiccolo, is still the most commonly used form of therapy for sexual dysfunctions; although it has shown results, the results do not consistently support that this is the best alternative in the treatment of sexual dysfunctions. Conclusion There is a lack of systematic study of many female sexual dysfunctions. Orgasmic disorder and sexual pain (vaginismus and dyspaurenia) are the most extensively studied disorders and those in which sex therapy seems to have better outcomes. PMID:24066697

2013-01-01

285

Perineal hernia: a case of outlet dysfunction.  

PubMed

This article describes and discusses a successfully treated case of a primary posterior perineal hernia which is a rare cause of outlet dysfunction. A 46-year-old female patient had a 6 cm left para-anal protrusion and a 7-year history of outlet dysfunction. The perineal hernia orifice was closed via an abdominal approach using both a polypropylene mesh and a Parietex Composite Net. A rectopexy to the promontory of the sacrum was then performed. Moreover, after 6 months' follow-up, the patient presented a sense of incomplete evacuation and underwent a prolassectomy to treat a hidden rectal prolapse. This clinical case shows that the surgical treatment of a pelvic pathology can be successful for the correction of a serious functional defect such as outlet dysfunction. PMID:19391352

Succi, Lino; Ohazuruike, Nnawuihe Luca; Oliveri, Conchita Emanuela; Privitera, Antonino Carlo; Prumeri, Serafina; Politi, Antonino; Garufi, Antonio; Randazzo, Giuseppe

2009-01-01

286

An uncommon cause of transient neurological dysfunction.  

PubMed

Transient neurological dysfunction may be associated with uncommon disorders and should prompt consideration of a broad differential diagnosis when assessing patients with episodic symptoms. The most common causes of transient neurological dysfunction include transient ischemic attack (TIA), seizure disorder, and migraine and its variants. However, underlying unusual pathophysiological processes such as brain tumors can also cause transient neurological dysfunction. Here we present a case of a 68-year-old male with oligodendroglial gliomatosis cerebri (OGC) who presented with TIA-like symptoms. Brain magnetic resonance imaging revealed multiple diffuse T2 hyperintensities within the white and gray matter. Magnetic resonance spectroscopy was suggestive of gliomatosis cerebri and was particularly helpful in this case. The diagnosis of OGC was confirmed by histopathology and molecular genetic studies on brain biopsy tissue. In this report, we discuss the clinical and radiological characteristics of OGC and highlight the unusual presentation of this case. PMID:24982718

Farooq, Muhammad U; Bhatt, Archit; Chang, Howard T

2014-07-01

287

An Uncommon Cause of Transient Neurological Dysfunction  

PubMed Central

Transient neurological dysfunction may be associated with uncommon disorders and should prompt consideration of a broad differential diagnosis when assessing patients with episodic symptoms. The most common causes of transient neurological dysfunction include transient ischemic attack (TIA), seizure disorder, and migraine and its variants. However, underlying unusual pathophysiological processes such as brain tumors can also cause transient neurological dysfunction. Here we present a case of a 68-year-old male with oligodendroglial gliomatosis cerebri (OGC) who presented with TIA-like symptoms. Brain magnetic resonance imaging revealed multiple diffuse T2 hyperintensities within the white and gray matter. Magnetic resonance spectroscopy was suggestive of gliomatosis cerebri and was particularly helpful in this case. The diagnosis of OGC was confirmed by histopathology and molecular genetic studies on brain biopsy tissue. In this report, we discuss the clinical and radiological characteristics of OGC and highlight the unusual presentation of this case. PMID:24982718

Bhatt, Archit; Chang, Howard T.

2014-01-01

288

Endothelial Dysfunction in Children Without Hypertension  

PubMed Central

Background: Endothelial dysfunction can develop in the context of both obesity and obstructive sleep apnea (OSA) in children. However, the potential interactions between OSA and obesity have not been defined. Methods: Children who were prepubertal and nonhypertensive were recruited. Endothelial function was assessed in a morning fasted state, using a modified hyperemic test involving cuff-induced occlusion of the radial and ulnar arteries, and blood was drawn for assessment of myeloid-related protein 8/14 (MRP8/14) levels using a commercial enzyme-linked immunosorbent assay. Overnight polysomnography defined the presence of OSA or absence of OSA (NOSA) in subjects investigated for sleep-disordered breathing. Anthropometric measurements were performed to assign subjects to obese (OB) and nonobese (NOB) categories. Results: Fifty-four children with OSA who were obese and nonobese (mean age, 7.90 ± 0.26 years; mean BMI z-score, 1.70 ± 0.3; obstructive apnea-hypopnea index [OAHI], 7.36 ± 1.09) were compared with 54 children without OSA who were obese and nonobese (mean age, 8.26 ± 0.24 years; mean BMI z-score, 1.41 ± 0.18; OAHI, 0.86 ± 0.07). Of those subjects, 62.5% of the OB-OSA category, 38.7% of the OB-NOSA category, and 20.0% of the NOB-OSA category had evidence of endothelial dysfunction, compared with 0.0% of the NOB-NOSA category (P < .01). The degree of endothelial dysfunction in all groups was associated with circulating MRP8/14 levels (r = 0.343, P < .001). Conclusions: Both obesity and OSA can independently increase the risk for endothelial dysfunction, and the concurrent presence of both markedly increases such risk. Although the mechanisms underlying endothelial dysfunction remain unclear, a potential role for MRP8/14 as an inflammatory biomarker of endothelial dysfunction is suggested. PMID:22030801

Kim, Jinkwan; Alotaibi, Wadha H.; Kheirandish-Gozal, Leila; Capdevila, Oscar Sans; Gozal, David

2012-01-01

289

Vertigo in patients with cervical spine dysfunction.  

PubMed

To our knowledge, quantitative studies on the significance of disorders of the upper cervical spine as a cause of vertigo or impaired hearing do not exist. We examined the cervical spines of 67 patients who presented with symptoms of dizziness. Prior to the orthopaedic examination, causes of vertigo relating to the field of ENT and neurology had been ruled out. Fifty patients of the above-mentioned group were studied. They followed the outlined treatment protocol with physical therapy and were available for 3 months of follow-up. Thirty-one patients, hereinafter referred to as group A, were diagnosed with dysfunctions of the upper cervical spine. Nineteen patients, hereinafter referred to as group B, did not show signs of dysfunction. Cervical spine dysfunctions were documented as published by Bischoff. In group A dysfunctions were found at level C1 in 14 cases, at level C2 in 6 cases and at level C3 in 4 cases. In seven cases more than one upper cervical spine motion segment was affected. Dysfunctions were treated and resolved with mobilising and manipulative techniques of manual medicine. Regardless of cervical spine findings seen at the initial visit, group A and B patients received intensive outpatient physical therapy. At the final 3-month follow-up, 24 patients of group A (77.4%) reported an improvement of their chief symptom and 5 patients were completely free of vertigo. Improvement of vertigo was recorded in 5 group B patients (26.3%); however, nobody in group B was free of symptoms. We concluded that a functional examination of motion segments of the upper cervical spine is important in diagnosing and treating vertigo, because a non-resolved dysfunction of the upper cervical spine was a common cause of long-lasting dizziness in our population. PMID:9548360

Galm, R; Rittmeister, M; Schmitt, E

1998-01-01

290

Evaluation and treatment of erectile dysfunction.  

PubMed

Erectile dysfunction has an organic etiology in most cases, with vascular disease the single most common cause. In addition to a thorough history and physical examination, clinical evaluation may include hormonal assessment, diabetes screening, nocturnal tumescence testing and color Doppler flow studies of the penile vasculature. Therapy for erectile dysfunction has progressed rapidly during the past decade, with alternatives including hormone supplements, vacuum constriction devices, penile self-injection therapy and penile prostheses. The majority of patients and their partners report satisfactory results with these treatments. PMID:8623722

DeWire, D M

1996-05-01

291

Temporomandibular Joint Dysfunction: A Dental Overview  

PubMed Central

Temporomandibular joint dysfunction is common and often acutely painful. Because of the large and diverse symptom complex created by this disorder, patients frequently first seek relief from their physician rather than their dentist. In this article temporomandibular joint (TMJ) dysfunction is defined and the presenting signs and symptoms are discussed. Their etiology is described in relation to the anatomy of the temporomandibular joint. Examination techniques can help in the differential diagnosis. Current treatment ranges from heat, local anesthesia and ultrasound to anxiolytics, transcutaneous nerve stimulation and nutritional supplementation. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6Fig. 7Fig. 8 PMID:21274225

Hillier, Clyde D.

1985-01-01

292

Female sexual dysfunction: definition, classification, and debates.  

PubMed

Sexual dysfunction refers to difficulties that occur during the sexual response cycle that prevent the individual from experiencing satisfaction from sexual activity. It is relatively difficult to estimate the prevalence of female sexual dysfunction (FSD), because the definition and diagnostic criteria are still controversial and under development. These difficulties reveal our insufficient understanding of the basis of FSD. This review was conducted in an effort to deal with this complicated clinical issue, by examining the most updated clinical criteria of FSD under the context of a redefined female sexual response model. PMID:23548211

Chen, Ching-Hui; Lin, Yen-Chin; Chiu, Li-Hsuan; Chu, Yuan-Hsiang; Ruan, Fang-Fu; Liu, Wei-Min; Wang, Peng-Hui

2013-03-01

293

[Endothelial microparticles and erectile dysfunction: an update].  

PubMed

Microparticles are submicron vesicles shed from plasma membranes in response to cell activation, injury and/or apoptosis. Microparticles of various cellular origins, such as platelets, leukocytes, and endothelial cells, are found in the plasma of healthy subjects, and their amount increases under pathological conditions. Recent studies show that endothelial microparticles, a kind of envelope particles derived from endothelial cells, not only constitute a marker of endothelial dysfunction, but also play a major biological role in the diagnostic and therapeutic approaches to erectile dysfunction. PMID:24218953

Li, Yong-Xian; Jiang, Rui; Yang, Guo-Sheng

2013-10-01

294

A mediator derived from arginine mediates inhibitory junction potentials and relaxations in lower esophageal sphincter: an independent role for vasoactive intestinal peptide.  

PubMed

This study provides mechanical and electrophysiological evidence to show that a metabolite of arginine, not vasoactive intestinal peptide (VIP), is the putative nonadrenergic noncholinergic (NANC) inhibitory mediator in canine and opossum lower esophageal sphincters (LES). Relaxations of spontaneous active tension by electrical field stimulation (FS) at parameters that induced tetrodotoxin (TTX)-sensitive responses were abolished by L-N omega-arginine methyl ester (L-NAME) at 10(-4) M and restored by L-arginine (10(-3) M) but not D-arginine (10(-3) M). TTX-insensitive relaxations to 5-ms pulses were unaffected by L-NAME, L- or D-arginine. VIP (10(-6) M) caused maximum relaxations of basal tension in both the opossum and canine LES. However these relaxations, unlike those from FS were unaffected by L-NAME. Methylene blue (5 x 10(-5)M) increased basal tension of the LES in each species, and did not inhibit the relaxation to FS or VIP, but often increased the amplitudes of these responses due to the increase in basal tension. In parallel experiments NANC inhibition of body circular muscle from opossum esophagus was abolished by methylene blue. Electrophysiological studies using micro-electrodes revealed that NANC inhibition was associated with inhibitory junction potentials in the canine LES. These were inhibited by L-NAME and restored by L-arginine but not D-arginine. In contrast, 10(-6) M VIP in canine LES did not induce any change in membrane potential during a 20-min superfusion. Sodium nitroprusside also hyperpolarized sphincteric muscle and its effects were not affected by L-NAME.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1473049

Jury, J; Ahmedzadeh, N; Daniel, E E

1992-08-01

295

SOMATOSENSORY DYSFUNCTION FOLLOWING ACUTE TRIMETHYLTIN EXPOSURE  

EPA Science Inventory

A variety of trimethyltin (TMT) -produced sensory and behavioral dysfunctions have been reported. In this study the functional integrity of the somatosensory system was evaluated. Animals were tested using three different measures prior to (day 0) and 1,4, and 16 days following d...

296

Minimal Brain Dysfunction: Associations with Perinatal Complications.  

ERIC Educational Resources Information Center

Examined with over 28,000 7-year-old children whose mothers registered for prenatal care was the relationship between perinatal complications and such characteristics as poor school achievement, hyperactivity, and neurological soft signs associated with the diagnosis of minimal brain dysfunction (MBD). Ten perinatal antecedents were studied:…

Nichols, Paul L.

297

Syllable Structure in Dysfunctional Portuguese Children's Speech  

ERIC Educational Resources Information Center

The goal of this work is to investigate whether children with speech dysfunctions (SD) show a deficit in planning some Portuguese syllable structures (PSS) in continuous speech production. Knowledge of which aspects of speech production are affected by SD is necessary for efficient improvement in the therapy techniques. The case-study is focused…

Candeias, Sara; Perdigao, Fernando

2010-01-01

298

Relationship Between Testosterone and Erectile Dysfunction  

PubMed Central

Although erectile function is clearly androgen dependent, is it just as clear at what level of testosterone erectile dysfunction (ED) begins? Does the decline in testosterone that occurs with aging always produce ED? Are exogenous androgens the answer to ED? The answers range from clear to complex. PMID:16985751

Rajfer, Jacob

2000-01-01

299

Biofeedback therapy for children with dysfunctional voiding  

Microsoft Academic Search

Objectives. Biofeedback therapy has been recognized as a treatment option for children with classic dysfunctional voiding (DV) where there is inadequate pelvic floor relaxation during voiding. However, there are few articles that discuss methodology and limited sites where it is available. In the hope of making biofeedback a more practical and accessible option, we report our indications, easy to duplicate

Andrew J Combs; Andrew D Glassberg; Dawn Gerdes; Mark Horowitz

1998-01-01

300

Neuromodulation of voiding dysfunction and pelvic pain  

Microsoft Academic Search

Neuromodulation of sacral roots provides an alternative mode of therapy for patients presenting with voiding dysfunctions and chronic pelvic pain. Physiologically, this is accomplished by intervention in the neuronal pathways of micturition via sacral nerve-root electrical stimulation. Preoperative evaluation using temporary percutaneous sacral root stimulation selects the patients who are most likely to benefit from permanent electrode implantation. To date,

W. F. Thon; L. S. Baskin; U. Jonas; E. A. Tanagho; R. A. Schmidt

1991-01-01

301

Mirror neuron dysfunction in autism spectrum disorders  

Microsoft Academic Search

Autism spectrum disorders (ASDs) are developmental conditions characterized by deficits in social interaction, verbal and nonverbal communication and obsessive\\/stereotyped patterns of behaviour. Although there is no reliable neurophysiological marker associated with ASDs, dysfunction of the parieto-frontal mirror neuron system has been suggested as a disturbance linked to the disorder. Mirror neurons (MNs) are visuomotor neurons which discharge both when performing

Tom Perkins; Mark Stokes; Jane McGillivray; Richard Bittar

2010-01-01

302

The treatment of secondary orgasmic dysfunction II  

Microsoft Academic Search

This study investigated the impact of group treatment on women with secondary orgasmic dysfunction and their partners. Eleven couples received 4 hours of basic sex education, after which seven of the couples received a Combination treatment format consisting of communication skills followed by sexual skills, while four of the couples received the opposite sequence. No significant differences were found between

Peter R. Kilmann; Richard J. Milan; Joseph P. Boland; Katherine H. Mills; Charlene Caid; Edward Davidson; Bonnie Bella; Richard Wanlass; Judy Sullivan; Bonnie Montgomery

1987-01-01

303

Hepatitis C Virus-Induced Mitochondrial Dysfunctions  

PubMed Central

Chronic hepatitis C is characterized by metabolic disorders and a microenvironment in the liver dominated by oxidative stress, inflammation and regeneration processes that lead in the long term to hepatocellular carcinoma. Many lines of evidence suggest that mitochondrial dysfunctions, including modification of metabolic fluxes, generation and elimination of oxidative stress, Ca2+ signaling and apoptosis, play a central role in these processes. However, how these dysfunctions are induced by the virus and whether they play a role in disease progression and neoplastic transformation remains to be determined. Most in vitro studies performed so far have shown that several of the hepatitis C virus (HCV) proteins localize to mitochondria, but the consequences of these interactions on mitochondrial functions remain contradictory, probably due to the use of artificial expression and replication systems. In vivo studies are hampered by the fact that innate and adaptive immune responses will overlay mitochondrial dysfunctions induced directly in the hepatocyte by HCV. Thus, the molecular aspects underlying HCV-induced mitochondrial dysfunctions and their roles in viral replication and the associated pathology need yet to be confirmed in the context of productively replicating virus and physiologically relevant in vitro and in vivo model systems. PMID:23518579

Brault, Charlène; Levy, Pierre L.; Bartosch, Birke

2013-01-01

304

Defective Artemis causes mild telomere dysfunction  

PubMed Central

Background Repair of DNA double strand breaks by non-homologous end joining (NHEJ) requires several proteins including Ku, DNA-PKcs, Artemis, XRCC4, Ligase IV and XLF. Two of these proteins, namely Ku and DNA-PKcs, are also involved in maintenance of telomeres, chromosome end-structures. In contrast, cells defective in Ligase IV and XRCC4 do not show changes in telomere length or function suggesting that these proteins are not involved in telomere maintenance. Since a mouse study indicated that defective Artemis may cause telomere dysfunction we investigated the effects of defective Artemis on telomere maintenance in human cells. Results We observed significantly elevated frequencies of telomeric fusions in two primary fibroblast cell lines established from Artemis defective patients relative to the control cell line. The frequencies of telomeric fusions increased after exposure of Artemis defective cells to ionizing radiation. Furthermore, we observed increased incidence of DNA damage at telomeres in Artemis defective cells that underwent more than 32 population doublings using the TIF (Telomere dysfunction Induced Foci) assay. We have also inhibited the expression levels of DNA-PKcs in Artemis defective cell lines by either using synthetic inhibitor (IC86621) or RNAi and observed their greater sensitivity to telomere dysfunction relative to control cells. Conclusion These results suggest that defective Artemis causes a mild telomere dysfunction phenotype in human cell lines. PMID:20678254

2010-01-01

305

Cardiovascular dysfunction in patients with liver cirrhosis  

PubMed Central

Hyperdynamic syndrome is a well-known clinical condition found in patients with cirrhosis and portal hypertension, characterized by increased heart rate and cardiac output, and reduced systemic vascular resistance and arterial blood pressure. The leading cause of hyperdynamic circulation in cirrhotic patients is peripheral and splanchnic vasodilatation, due to an increased production/activity of vasodilator factors and decreased vascular reactivity to vasoconstrictors. The term “cirrhotic cardiomyopathy” describes impaired contractile responsiveness to stress, diastolic dysfunction and electrophysiological abnormalities in patients with cirrhosis without known cardiac disease. Underlying circulatory and cardiac dysfunctions are the main determinant in the development of hepatorenal syndrome in advanced cirrhosis. Moreover, the clinical consequences of cirrhosis-related cardiovascular dysfunction are evident during and after liver transplantation, and after transjugular intrahepatic portosystemic shunt insertion. Cardiovascular complications following these procedures are common, with pulmonary edema being the most common complication. Other complications include overt heart failure, arrhythmia, pulmonary hypertension, pericardial effusion, and cardiac thrombus formation. This review discusses the circulatory and cardiovascular dysfunctions in cirrhosis, examining the pathophysiologic and clinical implications in light of the most recent published literature. PMID:25608575

Fede, Giuseppe; Privitera, Graziella; Tomaselli, Tania; Spadaro, Luisa; Purrello, Francesco

2015-01-01

306

Cerebral dysfunction after coronary artery bypass surgery.  

PubMed

Cerebral dysfunction after cardiac surgery remains a devastating complication and is growing in importance with our aging populations. Neurological complications following cardiac surgery can be classified broadly as stroke, encephalopathy (including delirium), or postoperative cognitive dysfunction (POCD). These etiologies are caused primary by cerebral emboli, hypoperfusion, or inflammation that has largely been attributed to the use of cardiopulmonary bypass. Preventative operative strategies, such as off-pump coronary artery bypass grafting (CABG), can potentially reduce the incidence of postoperative neurological complications by avoiding manipulation of the ascending aorta. Although off-pump CABG is associated with reduced risk of stroke, there are no convincing differences in POCD between off-pump and on-pump CABG. Recently, the focus of postoperative neurological research has shifted from managing cardiopulmonary bypass to patient-related factors. Identifying changes in brains of aged individuals undergoing cardiac surgery may improve strategies for preventing cerebral dysfunction. Advanced age is associated with more undiagnosed cerebrovascular disease and is a major risk factor for stroke and POCD following cardiac surgery. Preoperative cerebrovascular evaluation and adaptation of surgical strategies will provide preventative approaches for cerebral dysfunction after CABG. This review focuses on recent findings of the relationship between perioperative stress and underlying fragility of the brain in cardiac surgical patients. PMID:23982856

Goto, Tomoko; Maekawa, Kengo

2014-04-01

307

Endothelial Dysfunction in Chronic Inflammatory Diseases  

PubMed Central

Chronic inflammatory diseases are associated with accelerated atherosclerosis and increased risk of cardiovascular diseases (CVD). As the pathogenesis of atherosclerosis is increasingly recognized as an inflammatory process, similarities between atherosclerosis and systemic inflammatory diseases such as rheumatoid arthritis, inflammatory bowel diseases, lupus, psoriasis, spondyloarthritis and others have become a topic of interest. Endothelial dysfunction represents a key step in the initiation and maintenance of atherosclerosis and may serve as a marker for future risk of cardiovascular events. Patients with chronic inflammatory diseases manifest endothelial dysfunction, often early in the course of the disease. Therefore, mechanisms linking systemic inflammatory diseases and atherosclerosis may be best understood at the level of the endothelium. Multiple factors, including circulating inflammatory cytokines, TNF-? (tumor necrosis factor-?), reactive oxygen species, oxidized LDL (low density lipoprotein), autoantibodies and traditional risk factors directly and indirectly activate endothelial cells, leading to impaired vascular relaxation, increased leukocyte adhesion, increased endothelial permeability and generation of a pro-thrombotic state. Pharmacologic agents directed against TNF-?-mediated inflammation may decrease the risk of endothelial dysfunction and cardiovascular disease in these patients. Understanding the precise mechanisms driving endothelial dysfunction in patients with systemic inflammatory diseases may help elucidate the pathogenesis of atherosclerosis in the general population. PMID:24968272

Steyers, Curtis M.; Miller, Francis J.

2014-01-01

308

Assessment of urinary dysfunction in the elderly.  

PubMed

This article discusses the significance of specific signs and symptoms in the history and physical examination as they apply to the lower urinary tract in the geriatric population. The relevant use of urodynamics, cystoscopy, and other innovative techniques that aid in the assessment of urinary dysfunction will be covered. PMID:2405981

Douenias, R; Yalla, S V; Badlani, G H

1990-02-01

309

Feeding and Swallowing Dysfunction in Genetic Syndromes  

ERIC Educational Resources Information Center

Children with genetic syndromes frequently have feeding problems and swallowing dysfunction as a result of the complex interactions between anatomical, medical, physiological, and behavioral factors. Feeding problems associated with genetic disorders may also cause feeding to be unpleasant, negative, or even painful because of choking, coughing,…

Cooper-Brown, Linda; Copeland, Sara; Dailey, Scott; Downey, Debora; Petersen, Mario Cesar; Stimson, Cheryl; Van Dyke, Don C.

2008-01-01

310

Obesity and sexual dysfunction, male and female  

Microsoft Academic Search

Obesity has become a worldwide public health problem of epidemic proportions, as it may decrease life expectancy by 7 years at the age of 40 years: excess bodyweight is now the sixth most important risk factor contributing to the overall burden of disease worldwide. Overweight and obesity may increase the risk of erectile dysfunction (ED) by 30–90% as compared with

K Esposito; F Giugliano; M Ciotola; M De Sio; M D'Armiento; D Giugliano

2008-01-01

311

Shyness and Dysfunction in Career Development.  

ERIC Educational Resources Information Center

Demonstrated a relationship between shyness and dysfunction in behaviors essential to career development in young adulthood: interpersonal orientation of expressed interests, frequency of career information-seeking, career decidedness, and expectations about the value of assertiveness in job interviews. Found shy men in particular significantly…

Phillips, Susan D.; Bruch, Monroe A.

1988-01-01

312

REVIEW ARTICLE Anaesthetics and postoperative cognitive dysfunction: a  

E-print Network

REVIEW ARTICLE Anaesthetics and postoperative cognitive dysfunction: a pathological mechanism Research Centre, Manesar, Gurgaon, India Summary With longevity, postoperative cognitive decline postoperative cognitive dysfunction. The aim of this review is to highlight the clinical aspects

Mandal, Pravat K.

313

Disruption of Fusion Results in Mitochondrial Heterogeneity and Dysfunction*S  

E-print Network

potential, and de- creased cellular respiration. Disruption of OPA1 by RNAi also blocked all mitochondrial retained low levels of mitochondrial fusion and escaped major cellular dysfunction. Analysis cellular defects, including poor cell growth, widespread hetero- geneity of mitochondrial membrane

Chan, David

314

Vascular dysfunctions following spinal cord injury  

PubMed Central

The aim of this article is to analyze the vascular dysfunctions occurring after spinal cord injury (SCI). Vascular dysfunctions are common complications of SCI. Cardiovascular disturbances are the leading causes of morbidity and mortality in both acute and chronic stages of SCI. Neuroanatomy and physiology of autonomic nervous system, sympathetic and parasympathetic, is reviewed. SCI implies disruption of descendent pathways from central centers to spinal sympathetic neurons, originating in intermediolateral nuclei of T1–L2 cord segments. Loss of supraspinal control over sympathetic nervous system results in reduced overall sympathetic activity below the level of injury and unopposed parasympathetic outflow through intact vagal nerve. SCI associates significant vascular dysfunction. Spinal shock occurs during the acute phase following SCI and it is a transitory suspension of function and reflexes below the level of the injury. Neurogenic shock, part of spinal shock, consists of severe arterial hypotension and bradycardia. Autonomic dysreflexia appears during the chronic phase, after spinal shock resolution, and it is a life–threatening syndrome of massive imbalanced reflex sympathetic discharge occurring in patients with SCI above the splanchnic sympathetic outflow (T5–T6). Arterial hypotension with orthostatic hypotension occurs in both acute and chronic phases. The etiology is multifactorial. We described a few factors influencing the orthostatic hypotension occurrence in SCI: sympathetic nervous system dysfunction, low plasma catecholamine levels, rennin–angiotensin–aldosterone activity, peripheral alpha–adrenoceptor hyperresponsiveness, impaired function of baroreceptors, hyponatremia and low plasmatic volume, cardiovascular deconditioning, morphologic changes in sympathetic neurons, plasticity within spinal circuits, and motor deficit leading to loss of skeletal muscle pumping activity. Additional associated cardiovascular concerns in SCI, such as deep vein thrombosis and long–term risk for coronary heart disease and systemic atherosclerosis are also described. Proper prophylaxis, including non–pharmacologic and pharmacological strategies, diminishes the occurrence of the vascular dysfunction following SCI. Each vascular disturbance requires a specific treatment. PMID:20945818

Popa, F; Grigorean, VT; Onose, G; Sandu, AM; Popescu, M; Burnei, G; Strambu, V; Sinescu, C

2010-01-01

315

Sudomotor dysfunction in autoimmune autonomic ganglionopathy  

PubMed Central

Background: Autoimmune autonomic ganglionopathy is characterized by impairment of multiple autonomic domains of which sudomotor function is among the most common. Many patients with this disorder have difficulties with thermoregulation and anhidrosis. Our objective was to characterize the distribution and severity of sudomotor dysfunction in this disorder. Methods: Sudomotor function was analyzed in a cohort of 21 patients with ganglionic ?3 nicotinic acetylcholine receptor (nAChR) antibody positive autoimmune autonomic ganglionopathy. Standard measurements of sudomotor function were used including the Thermoregulatory Sweat Test and Quantitative Sudomotor Axon Reflex Test. Results: The clinical presentation in all patients was characterized by widespread sudomotor dysfunction. Sudomotor impairment was predominantly postganglionic in 17 of the 21 patients studied. Higher ganglionic ?3 nAChR antibody levels resulted in progressive postganglionic predominant dysfunction (postganglionic, r = 0.637, p = 0.002; mixed ganglionic, r = 0.709, p < 0.001). The pattern of anhidrosis on Thermoregulatory Sweat Testing was consistent with a ganglionopathy in the majority of patients (14 of 21) and a distal pattern in a minority of patients (8 of 21). These patterns of anhidrosis coupled with increasing postganglionic dysfunction in a proximal to distal pattern (foot > distal leg > proximal leg > forearm) indicate lesions at both the ganglia and distal axon of the postganglionic sudomotor sympathetic neuron. Conclusions: Our data characterize the unique sudomotor dysfunction in autoimmune autonomic ganglionopathy as widespread, predominantly postganglionic, and a result of lesions at both the ganglia and distal axon. This study provides important support to the hypothesis that this disorder represents a ganglionic neuropathy. GLOSSARY AAG = autoimmune autonomic ganglionopathy; CASS = Composite Autonomic Severity Score; nAChR = nicotinic acetylcholine receptor; QSART = Quantitative Sudomotor Axon Reflex Testing; TST = Thermoregulatory Sweat Test. PMID:19884578

Kimpinski, K; Iodice, V; Sandroni, P; Fealey, R D.; Vernino, S; Low, P A.

2009-01-01

316

The role of anxiety in sexual dysfunctions: A review  

Microsoft Academic Search

Studies are reviewed which (a) compare anxiety and other measures of psychopathology between normals and dysfunctionals; (b) evaluate the effectiveness of anxiety reduction procedures for treating sexual dysfunctions; and (c) try to identify anxiety-related stimuli that alter sexual arousal. The studies, in general, suggest that (a) anxiety is common among people with sexual dysfunctions, but that the level and nature

G. R. Norton; Derek Jehu

1984-01-01

317

Valvar prosthetic dysfunction. Localisation and evaluation of the dysfunction using the Doppler technique.  

PubMed Central

Thirty patients with 33 mitral or aortic prostheses or both were examined using the pulsed Doppler technique combined with cross sectional echocardiography to study the applicability of the Doppler technique in the diagnosis and evaluation of the severity of prosthetic dysfunction and to assess the ability of the mapping procedure to estimate the site and the size of the prosthetic defect. The dysfunction was valvar regurgitation in 29 instances and stenoses in eight, all of which were confirmed by invasive procedures. The severity of the dysfunction was graded on a three point scale. A control group of 73 subjects with 88 normal prostheses also underwent pulsed Doppler and cross sectional echocardiography. The pulsed Doppler study followed the usual procedure for a valvar disease including two and three dimensional mapping for regurgitation. Eight patients also underwent a continuous wave Doppler examination. The diagnostic reliability of the pulsed Doppler technique was greater than or equal to 90%. The severity of the dysfunction was accurately assessed in 86% of cases. In the case of aortic regurgitation, mapping of the jets was performed as easily for prostheses as for native regurgitant valves. In the case of mitral regurgitation, the mapping patterns depended on the cause of the dysfunction. With valvar tears, a jet was detected at the centre of the annulus, and with paravalvar leaks eccentric atrial jets were seen opposite the site of the leak. The pulsed Doppler and the surgical findings correlated well for both the site of the dysfunction (16/20 (80%) patients) and the size of the leak (13/16 (81%) patients). Thus, despite some limitations, pulsed Doppler and particularly the mapping procedure provide sufficient information to give an accurate non-invasive assessment of prosthetic valve dysfunction. Images PMID:3899151

Veyrat, C; Witchitz, S; Lessana, A; Ameur, A; Abitbol, G; Kalmanson, D

1985-01-01

318

Mitochondrial dysfunction and insulin resistance: an update  

PubMed Central

Mitochondrial dysfunction has been implicated in the development of insulin resistance (IR); however, a large variety of association and intervention studies as well as genetic manipulations in rodents have reported contrasting results. Indeed, even 39 years after the first publication describing a relationship between IR and diminished mitochondrial function, it is still unclear whether a direct relationship exists, and more importantly if changes in mitochondrial capacity are a cause or consequence of IR. This review will take a journey through the past and summarise the debate about the occurrence of mitochondrial dysfunction and its possible role in causing decreased insulin action in obesity and type 2 diabetes. Evidence is presented from studies in various human populations, as well as rodents with genetic manipulations of pathways known to affect mitochondrial function and insulin action. Finally, we have discussed whether mitochondria are a potential target for the treatment of IR. PMID:25385852

Montgomery, Magdalene K; Turner, Nigel

2014-01-01

319

Mental dysfunctions in dystonia-plus syndromes.  

PubMed

With the increasing understanding of the involvement of basal ganglia circuits in the functions of movement, cognition, emotion and motivation, the network model of dystonia posits a plausible mechanism for the co-occurrence of mental dysfunctions in dystonia-plus syndromes. Genetic mutations that alter the production of neurotransmitters and receptors can potentially affect the function of these interconnecting circuits and yield non-motor symptoms as well. This article reviews the psychiatric findings in dystonia-plus syndromes reported thus far in the literature, both in animal models and human subjects. Based on this innovative understanding of the pathophysiology, implications to treatment of combined motor and non-motor symptoms (i.e. mental dysfunctions) are also briefly discussed. PMID:24796232

Sunga, Mary Anne P; Rosales, Raymond L

2014-01-01

320

Mitochondrial dysfunction and insulin resistance: an update.  

PubMed

Mitochondrial dysfunction has been implicated in the development of insulin resistance (IR); however, a large variety of association and intervention studies as well as genetic manipulations in rodents have reported contrasting results. Indeed, even 39 years after the first publication describing a relationship between IR and diminished mitochondrial function, it is still unclear whether a direct relationship exists, and more importantly if changes in mitochondrial capacity are a cause or consequence of IR. This review will take a journey through the past and summarise the debate about the occurrence of mitochondrial dysfunction and its possible role in causing decreased insulin action in obesity and type 2 diabetes. Evidence is presented from studies in various human populations, as well as rodents with genetic manipulations of pathways known to affect mitochondrial function and insulin action. Finally, we have discussed whether mitochondria are a potential target for the treatment of IR. PMID:25385852

Montgomery, Magdalene K; Turner, Nigel

2015-03-01

321

Mitochondrial dysfunction and neurodegeneration in multiple sclerosis  

PubMed Central

Multiple sclerosis (MS) has traditionally been considered an autoimmune inflammatory disorder leading to demyelination and clinical debilitation as evidenced by our current standard anti-inflammatory and immunosuppressive treatment regimens. While these approaches do control the frequency of clinical relapses, they do not prevent the progressive functional decline that plagues many people with MS. Many avenues of research indicate that a neurodegenerative process may also play a significant role in MS from the early stages of disease, and one of the current hypotheses identifies mitochondrial dysfunction as a key contributing mechanism. We have hypothesized that pathological permeability transition pore (PTP) opening mediated by reactive oxygen species (ROS) and calcium dysregulation is central to mitochondrial dysfunction and neurodegeneration in MS. This focused review highlights recent evidence supporting this hypothesis, with particular emphasis on our in vitro and in vivo work with the mitochondria-targeted redox enzyme p66ShcA. PMID:23898299

Su, Kimmy; Bourdette, Dennis; Forte, Michael

2013-01-01

322

Vesicourethral dysfunction following pelvic visceral ablative surgery.  

PubMed

Management of vesicourethral dysfunction after a major extirpative pelvic visceral operation could be complex and difficult owing to the variety of partial and complete functional and anatomical derangements produced by the primary operation. We report our experience with 22 patients who suffered various types of vesicourethral dysfunctions after extirpative pelvic visceral surgery, 5 of whom had preoperative studies. The surgical procedures were abdominoperineal resection in 9 patients, proctocolectomy in 3, anterior resection of the rectum in 2 and radical hysterectomy in 8. All 22 patients underwent urodynamic evaluations. The abnormalities noted on the preoperative urodynamic evaluations in patients about to undergo extirpative pelvic visceral surgery suggest the need for routine preoperative assessment of the lower urinary tract for an accurate understanding of the postoperative changes. PMID:6471186

Yalla, S V; Andriole, G L

1984-09-01

323

Antioxidants and endothelial dysfunction in Hyperlipidemia  

Microsoft Academic Search

Endothelial function is abnormal in a variety of diseased states such as hypercholesterolemia and atherosclerosis. This may\\u000a be secondary to decreased synthesis of nitric oxide (NO) and\\/or increased degradation of NO due to interaction with superoxide\\u000a anions. More recent experimental observations demonstrate increased production of superoxide in hyperlipidemia, suggesting\\u000a that endothelial dysfunction in these states is in part secondary to

Ascan Warnholtz; Hanke Mollnau; Mathias Oelze; Maria Wendt; Thomas Münzel

2001-01-01

324

Minor Neurological Dysfunction in Children with Dyslexia  

ERIC Educational Resources Information Center

Aim: To improve understanding of brain function in children with severe dyslexia in terms of minor neurological dysfunctions (MNDs). Method: One hundred and four children (81 males, 23 females; age range 7-12y; mean age 9y 7mo, SD 1y 2mo;) with severe dyslexia (the presence of a Full-scale IQ score of greater than or equal to 85, retardation in…

Punt, Marja; de Jong, Marianne; de Groot, Erik; Hadders-Algra, Mijna

2010-01-01

325

Oculomotor dysfunction in patients with syphilis.  

PubMed Central

Four patients with syphilis or, in two instances, possibly some other treponematosis, underwent oculomotor and audiological tests. The oculomotor test result was abnormal in all four patients. Three had abnormal smooth pursuit eye movements and two of them had hypometric voluntary horizontal saccades, which indicate that the central nervous system (CNS) was affected. Moreover, one of the patients had pathological auditory brain stem responses, which indicate brain stem dysfunction. Another patient had signs of Menière's syndrome in one ear. PMID:3583275

Rosenhall, U; Löwhagen, G B; Roupe, G

1987-01-01

326

Oculomotor dysfunction in patients with syphilis.  

PubMed

Four patients with syphilis or, in two instances, possibly some other treponematosis, underwent oculomotor and audiological tests. The oculomotor test result was abnormal in all four patients. Three had abnormal smooth pursuit eye movements and two of them had hypometric voluntary horizontal saccades, which indicate that the central nervous system (CNS) was affected. Moreover, one of the patients had pathological auditory brain stem responses, which indicate brain stem dysfunction. Another patient had signs of Menière's syndrome in one ear. PMID:3583275

Rosenhall, U; Löwhagen, G B; Roupe, G

1987-04-01

327

Adenosine dysfunction and adenosine kinase in epileptogenesis  

PubMed Central

Traditionally, epilepsy has been considered to be a disorder of neuronal dysfunction. Based on this dogma, drug development efforts have largely focused on neurocentric model systems to screen for compounds that affect the function of neurons. Unfortunately, about 30% of all patients with epilepsy – or more than 20 million worldwide – are refractory to classical neurocentric pharmacotherapy. The failure of neurocentric pharmacotherapy in epilepsy requires radical rethinking and the search for novel therapeutic targets. Research from recent years suggests that epilepsy is a disorder of astrocyte dysfunction. Astrocytes are key regulators of the brain’s own anticonvulsant adenosine. Thus, any dysfunction in astrocyte metabolism will drastically affect the brain’s ability to control excitability via adenosinergic neuromodulation. This review will focus on the astrocyte-based enzyme adenosine kinase (ADK) as the key regulator of synaptic adenosine. Astrogliosis – a pathological hallmark of the epileptic brain – leads to overexpression of the adenosine-removing enzyme ADK and therefore to adenosine deficiency. Evidence from transgenic animals demonstrates that overexpression of ADK per se is sufficient to trigger seizures. Consequently, pharmacological inhibition of ADK is very effective in suppressing seizures that are refractory to classical antiepileptic drugs. The recent definition of ADK as rational target to predict and to prevent seizures in epilepsy has prompted the development of focal adenosine augmentation therapies (AATs) that have been designed to selectively reconstitute adenosinergic signalling within an area of astrogliosis-based adenosine-dysfunction. This therapeutic challenge has experimentally been met with polymeric or stem cell based brain implants to afford the focal delivery of adenosine. PMID:20730044

Boison, Detlev

2010-01-01

328

Multiple cranial nerve dysfunction caused by neurosarcoidosis.  

PubMed

Neurosarcoidosis is a rare identity and occurs in only 5% to 15% of patients with sarcoidosis. It can manifest in many different ways, and therefore, diagnosis may be complicated. We report a case presented in a very unusual manner with involvement of 3 cranial nerves; anosmia (NI), facial palsy (NVII), and hearing loss (NVIII). When cranial nerve dysfunction occurs, it is very important to take neurosarcoidosis into consideration. PMID:22154016

Loor, Rivkah G J; van Tongeren, Joost; Derks, Wynia

2012-01-01

329

Multiorgan dysfunction related to chronic ketamine abuse  

PubMed Central

Ketamine abuse is being increasingly reported worldwide. The drug can produce a dissociative state and hallucinations, making ketamine a favorite recreational agent among drug addicts. Chronic ketamine abuse can damage many organs, including the brain, heart, liver, gastrointestinal tract, and genitourinary system. We report a patient with chronic ketamine abuse who presented with severe cachexia, upper gastrointestinal involvement, hepatobiliary dysfunction, and acute kidney injury. PMID:24982568

Raj, Binu; Thomas, Sebastian; Hanna, Fahmy W.

2014-01-01

330

PDE5 inhibitors beyond erectile dysfunction  

Microsoft Academic Search

The phosphodiesterase type-5 (PDE5) inhibitors sildenafil, vardenafil and tadalafil are widely used first-line therapy for erectile dysfunction (ED). Since the advent of sildenafil in 1998, more than 40 million men worldwide have been successfully treated with these compounds. The safety and high tolerability of PDE5 inhibitors make them an attractive tool to investigate further physiological functions of PDE5, for example

P Sandner; J Hütter; H Tinel; K Ziegelbauer; E Bischoff

2007-01-01

331

Exploring Myelin Dysfunction in Multiple System Atrophy  

PubMed Central

Multiple system atrophy (MSA) is a rare, yet fatal neurodegenerative disease that presents clinically with autonomic failure in combination with parkinsonism or cerebellar ataxia. MSA impacts on the autonomic nervous system affecting blood pressure, heart rate and bladder function, and the motor system affecting balance and muscle movement. The cause of MSA is unknown, no definitive risk factors have been identified, and there is no cure or effective treatment. The definitive pathology of MSA is the presence of ?-synuclein aggregates in the brain and therefore MSA is classified as an ?-synucleinopathy, together with Parkinson's disease and dementia with Lewy bodies. Although the molecular mechanisms of misfolding, fibrillation and aggregation of ?-synuclein partly overlap with other ?-synucleinopathies, the pathological pathway of MSA is unique in that the principal site for ?-synuclein deposition is in the oligodendrocytes rather than the neurons. The sequence of pathological events of MSA is now recognized as abnormal protein redistributions in oligodendrocytes first, followed by myelin dysfunction and then neurodegeneration. Oligodendrocytes are responsible for the production and maintenance of myelin, the specialized lipid membrane that encases the axons of all neurons in the brain. Myelin is composed of lipids and two prominent proteins, myelin basic protein and proteolipid protein. In vitro studies suggest that aberration in protein distribution and lipid transport may lead to myelin dysfunction in MSA. The purpose of this perspective is to bring together available evidence to explore the potential role of ?-synuclein, myelin protein dysfunction, lipid dyshomeostasis and ABCA8 in MSA pathogenesis. PMID:25548533

Wong, Joanna H.; Halliday, Glenda M.

2014-01-01

332

Vascular dysfunction in obesity and insulin resistance.  

PubMed

With the growing prevalence of obesity and impaired glycemic control, and the correlation between these conditions and an elevated predisposition for the development of vascular disease, research emphases are increasingly being targeted to the mechanistic bases and functional outcomes of these relationships. Given this, the current issue of Microcirculation, presents a series of reviews that summarize knowledge on an array of topics relevant to obesity, insulin resistance, and vascular dysfunction. The first chapters discuss altered patterns of blood flow regulation, vascular reactivity, microvascular density, and vascular wall mechanics. The second grouping details alterations to coronary, renal, and hepatic circulations and the implications of these effects for organ function. Additionally, one article presents knowledge and outlines future research directions for the study of endothelial permeability and barrier function within insulin resistance. The last group of articles discusses the effects of inflammation with obesity and insulin resistance on vascular function, and also details the role of perivascular adipose tissue in contributing to vascular dysfunction. The final review extends this general topic to the effects of the metabolic syndrome on microvascular dysfunction, wherein obesity and impaired glycemic control are contributing elements to a larger constellation of systemic pathologies. The authors hope that this Special Topics Issue will be informative for its readers and will provide a basis for future investigation into microvasculopathy in obesity and insulin-resistance. PMID:17613800

Frisbee, Jefferson C

2007-01-01

333

Ammonia drives dendritic cells into dysfunction.  

PubMed

Ammonia levels are often elevated in patients with cirrhosis or tumors. Patients with these diseases are immunocompromised. In this study, we investigated the effects of ammonia on a member of the immune cell family, the dendritic cells (DCs). Our results demonstrated that ammonia diminished cell count, phagocytosis, and lymphocyte stimulation of DCs. Ammonia also induced DC swelling, excessive reactive oxygen species production, and mitochondrial damage, which may constitute the underlying mechanism of ammonia-induced DC dysfunction. In ammonium chloride (NH4Cl)-loaded mice, DCs exhibited lowered phagocytosis and a weakened immune response to the chicken OVA vaccine. DCs from patients with cirrhosis or ammonia-treated healthy human blood both exhibited diminished phagocytosis. Moreover, tumor cell conditioned medium drove DCs into dysfunction, which could be reversed by ammonia elimination. In a murine colon carcinoma model, we found that ammonia could regulate tumor growth involving DCs and their related immune response. These findings reveal that ammonia could drive DCs into dysfunction, which contributes to the immunocompromised state of patients with cirrhosis or tumors. PMID:24965775

Luo, Can; Shen, Guobo; Liu, Ning; Gong, Fengming; Wei, Xiawei; Yao, Shaohua; Liu, Dan; Teng, Xiu; Ye, Ning; Zhang, Nan; Zhou, Xikun; Li, Jiong; Yang, Li; Zhao, Xia; Yang, Li; Xiang, Rong; Wei, Yu-Quan

2014-08-01

334

Endothelial dysfunction in adipose triglyceride lipase deficiency.  

PubMed

Systemic knockout of adipose triglyceride lipase (ATGL), the pivotal enzyme of triglyceride lipolysis, results in a murine phenotype that is characterized by progredient cardiac steatosis and severe heart failure. Since cardiac and vascular dysfunction have been closely related in numerous studies we investigated endothelium-dependent and -independent vessel function of ATGL knockout mice. Aortic relaxation studies and Langendorff perfusion experiments of isolated hearts showed that ATGL knockout mice suffer from pronounced micro- and macrovascular endothelial dysfunction. Experiments with agonists directly targeting vascular smooth muscle cells revealed the functional integrity of the smooth muscle cell layer. Loss of vascular reactivity was restored ~50% upon treatment of ATGL knockout mice with the PPAR? agonist Wy14,643, indicating that this phenomenon is partly a consequence of impaired cardiac contractility. Biochemical analysis revealed that aortic endothelial NO synthase expression and activity were significantly reduced in ATGL deficiency. Enzyme activity was fully restored in ATGL mice treated with the PPAR? agonist. Biochemical analysis of perivascular adipose tissue demonstrated that ATGL knockout mice suffer from perivascular inflammatory oxidative stress which occurs independent of cardiac dysfunction and might contribute to vascular defects. Our results reveal a hitherto unrecognized link between disturbed lipid metabolism, obesity and cardiovascular disease. PMID:24657704

Schrammel, Astrid; Mussbacher, Marion; Wölkart, Gerald; Stessel, Heike; Pail, Karoline; Winkler, Sarah; Schweiger, Martina; Haemmerle, Guenter; Al Zoughbi, Wael; Höfler, Gerald; Lametschwandtner, Alois; Zechner, Rudolf; Mayer, Bernd

2014-06-01

335

Endothelial dysfunction in adipose triglyceride lipase deficiency  

PubMed Central

Systemic knockout of adipose triglyceride lipase (ATGL), the pivotal enzyme of triglyceride lipolysis, results in a murine phenotype that is characterized by progredient cardiac steatosis and severe heart failure. Since cardiac and vascular dysfunction have been closely related in numerous studies we investigated endothelium-dependent and -independent vessel function of ATGL knockout mice. Aortic relaxation studies and Langendorff perfusion experiments of isolated hearts showed that ATGL knockout mice suffer from pronounced micro- and macrovascular endothelial dysfunction. Experiments with agonists directly targeting vascular smooth muscle cells revealed the functional integrity of the smooth muscle cell layer. Loss of vascular reactivity was restored ~ 50% upon treatment of ATGL knockout mice with the PPAR? agonist Wy14,643, indicating that this phenomenon is partly a consequence of impaired cardiac contractility. Biochemical analysis revealed that aortic endothelial NO synthase expression and activity were significantly reduced in ATGL deficiency. Enzyme activity was fully restored in ATGL mice treated with the PPAR? agonist. Biochemical analysis of perivascular adipose tissue demonstrated that ATGL knockout mice suffer from perivascular inflammatory oxidative stress which occurs independent of cardiac dysfunction and might contribute to vascular defects. Our results reveal a hitherto unrecognized link between disturbed lipid metabolism, obesity and cardiovascular disease. PMID:24657704

Schrammel, Astrid; Mussbacher, Marion; Wölkart, Gerald; Stessel, Heike; Pail, Karoline; Winkler, Sarah; Schweiger, Martina; Haemmerle, Guenter; Al Zoughbi, Wael; Höfler, Gerald; Lametschwandtner, Alois; Zechner, Rudolf; Mayer, Bernd

2014-01-01

336

Hypothalamic dysfunction following whole-brain irradiation  

SciTech Connect

The authors describe 15 cases with evidence of hypothalamic dysfunction 2 to 9 years following megavoltage whole-brain x-irradiation for primary glial neoplasm. The patients received 4000 to 5000 rads in 180- to 200-rad fractions. Dysfunction occurred in the absence of computerized tomography-delineated radiation necrosis or hypothalamic invasion by tumor, and antedated the onset of dementia. Fourteen patients displayed symptoms reflecting disturbances of personality, libido, thirst, appetite, or sleep. Hyperprolactinemia (with prolactin levels up to 70 ng/ml) was present in all of the nine patients so tested. Of seven patients tested with thyrotropin-releasing hormone, one demonstrated an abnormal pituitary gland response consistent with a hypothalamic disorder. Seven patients developed cognitive abnormalities. Computerized tomography scans performed a median of 4 years after tumor diagnosis revealed no hypothalamic tumor or diminished density of the hypothalamus. Cortical atrophy was present in 50% of cases and third ventricular dilatation in 58%. Hypothalamic dysfunction, heralded by endocrine, behavioral, and cognitive impairment, represents a common, subtle form of radiation damage.

Mechanick, J.I.; Hochberg, F.H.; LaRocque, A.

1986-10-01

337

Profile of Gaze Dysfunction following Cerebrovascular Accident.  

PubMed

Aim. To evaluate the profile of ocular gaze abnormalities occurring following stroke. Methods. Prospective multicentre cohort trial. Standardised referral and investigation protocol including assessment of visual acuity, ocular alignment and motility, visual field, and visual perception. Results. 915 patients recruited: mean age 69.18 years (SD 14.19). 498 patients (54%) were diagnosed with ocular motility abnormalities. 207 patients had gaze abnormalities including impaired gaze holding (46), complete gaze palsy (23), horizontal gaze palsy (16), vertical gaze palsy (17), Parinaud's syndrome (8), INO (20), one and half syndrome (3), saccadic palsy (28), and smooth pursuit palsy (46). These were isolated impairments in 50% of cases and in association with other ocular abnormalities in 50% including impaired convergence, nystagmus, and lid or pupil abnormalities. Areas of brain stroke were frequently the cerebellum, brainstem, and diencephalic areas. Strokes causing gaze dysfunction also involved cortical areas including occipital, parietal, and temporal lobes. Symptoms of diplopia and blurred vision were present in 35%. 37 patients were discharged, 29 referred, and 141 offered review appointments. 107 reviewed patients showed full recovery (4%), partial improvement (66%), and static gaze dysfunction (30%). Conclusions. Gaze dysfunction is common following stroke. Approximately one-third of patients complain of visual symptoms, two thirds show some improvement in ocular motility. PMID:24558601

Rowe, Fiona J; Wright, David; Brand, Darren; Jackson, Carole; Harrison, Shirley; Maan, Tallat; Scott, Claire; Vogwell, Linda; Peel, Sarah; Akerman, Nicola; Dodridge, Caroline; Howard, Claire; Shipman, Tracey; Sperring, Una; Macdiarmid, Sonia; Freeman, Cicely

2013-01-01

338

Functional Outcomes and Long-term Durability of Artificial Urinary Sphincter Application: Review of 56 Patients With Long-term Follow-up  

PubMed Central

Purpose To evaluate the long-term outcomes of artificial urinary sphincter (AUS) implantation and to report the complication rates, including mechanical failure, erosion, and infection. Materials and Methods From June 1990 to May 2011, AUS (AMS 800) implantations were performed in 56 adult males by one surgeon. Various demographic and preoperative variables, surgical variables, and postoperative outcomes, including success and complication rates with a median follow-up of 96 months, were recorded retrospectively. Results The mean age of the patients at the time of AUS implantation was 61.8 (±14.2) years. During the follow-up period, the total complication rate was 41.1% (23 patients). The incidence of complications was significantly lower during the follow-up period after 48 months (p<0.05). Kaplan-Meier analysis revealed that 5- and 10-year failure-free rates were 50.3% and 45.2%, respectively. Conclusions Long-term durability and functional outcomes are achievable for the AMS 800, but there are appreciable complication rates for erosion, mechanical failure, and infection of up to 30%. PMID:23789045

Gülp?nar, Ömer; Süer, Evren; Halilo?lu, Ahmet Hakan; Öztürk, Erdem; Ar?kan, Nihat

2013-01-01

339

Roles of olfactory system dysfunction in depression.  

PubMed

The olfactory system is involved in sensory functions, emotional regulation and memory formation. Olfactory bulbectomy in rat has been employed as an animal model of depression for antidepressant discovery studies for many years. Olfaction is impaired in animals suffering from chronic stress, and patients with clinical depression were reported to have decreased olfactory function. It is believed that the neurobiological bases of depression might include dysfunction in the olfactory system. Further, brain stimulation, including nasal based drug delivery could provide novel therapies for management of depression. PMID:24879990

Yuan, Ti-Fei; Slotnick, Burton M

2014-10-01

340

Urodynamic Risk Factors for Renal Dysfunction in Men With Obstructive and Nonobstructive Voiding Dysfunction  

Microsoft Academic Search

PurposeUrodynamic investigation of men with lower urinary tract symptoms, usually attributed to benign prostatic hyperplasia, often reveals bladder outlet obstruction, detrusor instability and\\/or diminished vesical compliance. We investigated whether these urodynamic abnormalities alone or in combination contribute to renal dysfunction.

Craig V. Comiter; Maryrose P. Sullivan; Richard S. Schacterle; Louis H. Cohen; Subbarao V. Yalla

1997-01-01

341

Diagnosing erectile dysfunction could save your patient’s life  

PubMed Central

Erectile dysfunction and coronary artery disease are increasingly recognized as different clinical manifestations of the same process. Because the smaller vessels of the penis may be affected by plaque burden much earlier than the larger coronary, internal carotid, and femoral arteries, men may present with symptoms of erectile dysfunction long before signs of cardiovascular disease manifest. This presents an opportunity for the urologist to not only treat the sexual dysfunction and uncover occult coronary disease, but also to screen for cardiac risk, as even men with mild arteriogenic erectile dysfunction may be at risk for cardiovascular disease. PMID:25243040

Brock, Gerald

2014-01-01

342

Tear Dysfunction and the Cornea: LXVII Edward Jackson Memorial Lecture  

PubMed Central

Purpose To describe the cause and consequence of tear dysfunction related corneal disease. Design Perspective on effects of tear dysfunction on the cornea Methods Evidence is presented on the effects of tear dysfunction on corneal morphology, function and health, as well as efficacy of therapies for tear dysfunction related corneal disease. Results Tear dysfunction is a prevalent eye disease and the most frequent cause for superficial corneal epithelial disease that results in corneal barrier disruption, an irregular optical surface, light scattering, optical aberrations and exposure and sensitization of pain sensing nerve endings (nociceptors). Tear dysfunction related corneal disease causes irritation and visual symptoms, such as photophobia, blurred and fluctuating vision that may decrease quality of life. Dysfunction of one or more components of the lacrimal functional unit results in changes in tear composition, including elevated osmolarity and increased concentrations of matrix metalloproteinases, inflammatory cytokines and chemokines. These tear compositional changes promote disruption of tight junctions, alter differentiation and accelerate death of corneal epithelial cells. Conclusions Corneal epithelial disease resulting from tear dysfunction causes eye irritation and decreases visual function. Clinical and basic research has improved understanding of the pathogenesis of tear dysfunction related corneal epithelial disease, as well as treatment outcomes. PMID:22019306

Pflugfelder, Stephen C.

2011-01-01

343

Cognitive Dysfunction after Experimental Febrile Seizures  

PubMed Central

While the majority of children with febrile seizures have an excellent prognosis, a small percentage are latter discovered to have cognitive impairment. Whether the febrile seizures produce the cognitive deficits or the febrile seizures are a marker or the result of underlying brain pathology is not clear from the clinical literature. We evaluated hippocampal and prefrontal cortex function in adult rats with a prior history of experimental febrile seizures as rat pups. All of the rat pups had MRI brain scans following the seizures. Rats subjected to experimental febrile seizures were found to have moderate deficits in working and reference memory and strategy shifting in the Morris water maze test. A possible basis for these hippocampal deficits involved abnormal firing rate and poor stability of hippocampal CA1 place cells, neurons involved in encoding and retrieval of spatial information. Additional derangements of interneuron firing in the CA1 hippocampal circuit suggested a complex network dysfunction in the rats. MRI T2 values in the hippocampus were significantly elevated in 50% of seizure-experiencing rats. Learning and memory functions of these T2-positive rats were significantly worse than those of T2-negative cohorts and of controls. We conclude that cognitive dysfunction involving the hippocampus and prefrontal cortex networks occur following experimental febrile seizures and that the MRI provides a potential biomarker for hippocampal deficits in a model of prolonged human febrile seizures. PMID:19000675

Dube, Celine M; Zhou, Jun-Li; Hamamura, Mark; Zhao, Qian; Ring, Alex; Abrahams, Jennifer; McIntyre, Katherine; Nalcioglu, Orhan; Shatskih, Tatiana; Baram, Tallie Z.; Holmes, Gregory L.

2009-01-01

344

Renal dysfunction in patients with thalassaemia  

PubMed Central

Summary Little is known about the effects of thalassaemia on the kidney. Characterization of underlying renal function abnormalities in thalassaemia is timely because the newer iron chelator, deferasirox, can be nephrotoxic. We aimed to determine the prevalence and correlates of renal abnormalities in thalassaemia patients, treated before deferasirox was widely available, using 24-h collections of urine. We calculated creatinine clearance and urine calcium-to-creatinine ratio and measured urinary ?2-microglobulin, albumin, and protein. We used multivariate modelling to identify clinical, therapeutic, and laboratory predictors of renal dysfunction. One-third of thalassaemia patients who were not regularly transfused had abnormally high creatinine clearance. Regular transfusions were associated with a decrease in clearance (P = 0·004). Almost one-third of patients with thalassaemia had hypercalciuria, and regular transfusions were associated with an increase in the frequency and degree of hypercalciuria (P < 0·0001). Albuminuria was found in over half of patients, but was not consistently associated with transfusion therapy. In summary, renal hyperfiltration, hypercalciuria, and albuminuria are common in thalassaemia. Higher transfusion intensity is associated with lower creatinine clearance but more frequent hypercalciuria. The transfusion effect needs to be better understood. Awareness of underlying renal dysfunction in thalassaemia can inform decisions now about the use and monitoring of iron chelation. PMID:21332704

Quinn, Charles T.; Johnson, Valerie L.; Kim, Hae-Young; Trachtenberg, Felicia; Vogiatzi, Maria G.; Kwiatkowski, Janet L.; Neufeld, Ellis J.; Fung, Ellen; Oliveri, Nancy; Kirby, Melanie; Giardina, Patricia J.

2014-01-01

345

Endovascular treatment of vasculogenic erectile dysfunction  

PubMed Central

The treatment of erectile dysfunction (ED) has been a fascination involving multiple medical specialities over the past century with urologic, cardiac and surgical experts all contributing knowledge toward this multifactorial disease. With the well-described association between ED and cardiovascular disease, angiography has been utilized to identify vasculogenic impotence. Given the success of endovascular drug-eluting stent (DES) placement for the treatment of coronary artery disease, there has been interest in using this same technology for the treatment of vasculogenic ED. For men with inflow stenosis, DES placement to bypass arterial lesions has recently been reported with a high technical success rate. Comparatively, endovascular embolization as an approach to correct veno-occlusive dysfunction has produced astonishing procedural success rates as well. However, after a thorough literature review, arterial intervention is only recommended for younger patients with isolated vascular injuries, typically from previous traumatic experiences. Short-term functional outcomes are less than optimal with long-term results yet to be determined. In conclusion, the hope for a minimally invasive approach to ED persists but additional investigation is required prior to universal endorsement. PMID:25532580

Kim, Edward D; Owen, Ryan C; White, Gregory S; Elkelany, Osama O; Rahnema, Cyrus D

2015-01-01

346

Chronic kidney disease and erectile dysfunction  

PubMed Central

Erectile dysfunction (ED) is a common condition among male chronic kidney disease (CKD) patients. Its prevalence is estimated to be approximately 80% among these patients. It has been well established that the production of nitric oxide from the cavernous nerve and vascular endothelium and the subsequent production of cyclic GMP are critically important in initiating and maintaining erection. Factors affecting these pathways can induce ED. The etiology of ED in CKD patients is multifactorial. Factors including abnormalities in gonadal-pituitary system, disturbance in autonomic nervous system, endothelial dysfunction, anemia (and erythropoietin deficiency), secondary hyperparathyroidism, drugs, zinc deficiency, and psychological problems are implicated in the occurrence of ED. An improvement of general conditions is the first step of treatment. Sufficient dialysis and adequate nutritional intake are necessary. In addition, control of anemia and secondary hyperparathyroidism is required. Changes of drugs that potentially affect erectile function may be necessary. Further, zinc supplementation may be necessary when zinc deficiency is suspected. Phosphodiesterase type 5 inhibitors (PDE5Is) are commonly used for treating ED in CKD patients, and their efficacy was confirmed by many studies. Testosterone replacement therapy in addition to PDE5Is may be useful, particularly for CKD patients with hypogonadism. Renal transplantation may restore erectile function. ED is an early marker of cardiovascular disease (CVD), which it frequently precedes; therefore, it is crucial to examine the presence of ED in CKD patients not only for the improvement of the quality of life but also for the prevention of CVD attack. PMID:25374815

Suzuki, Etsu; Nishimatsu, Hiroaki; Oba, Shigeyoshi; Takahashi, Masao; Homma, Yukio

2014-01-01

347

Type 2 Diabetes: Endothelial dysfunction and Exercise  

PubMed Central

[Purpose] Vascular endothelial dysfunction is an early marker of atherosclerosis characterized by decreased nitric oxide bioavailability in the vascular endothelium and smooth muscle cells. Recently, some animal models and in vitro trials demonstrated that excessive superoxide production from mitochondria within vascular endothelial cells played a role in the pathogenesis of atherosclerosis in type 2 diabetes. This review provides a systematic assessment of the effectiveness of exercise to identify effective approaches to recognize diabetes risk and prevent progression to heart disease. [Methods] A systematic literature search was conducted to retrieve articles from 1979 to 2013 using the following databases: the MEDLINE, PubMed. Articles had to describe an intervention that physical activity and exercise to identify effective approaches to heart and vascular endothelium. [Results] Currently, physical activity and exercise guidelines aimed to improve cardiovascular health in patients with type 2 diabetes are nonspecific. Benefit of aerobic exercise training on vascular endothelial function in type 2 diabetic patients is still controversial. [Conclusion] it is necessary to demonstrate the mechanism of endothelial dysfunction from live human tissues so that we can provide more specific exercise training regimens to enhance cardiovascular health in type 2 diabetic patients.

Hwang, Moon-Hyon; Kim, Sangho

2014-01-01

348

COGNITIVE DYSFUNCTION IN FMR1 PREMUTATION CARRIERS  

PubMed Central

Premutation carriers of the fragile X mental retardation gene (especially men) older than 50 may develop a neurodegenerative disease, the fragile X-associated tremor/ataxia syndrome (FXTAS). Carriers may present with varied cognitive impairments. Attention, working memory, declarative and procedural learning, information processing speed, and recall are among the cognitive domains affected. Executive dysfunction is a prominent deficit, which has been demonstrated mostly in men with FXTAS. In more advanced stages of FXTAS, both men and women may develop a mixed cortical-subcortical dementia, manifested by psychomotor slowing and deficits in attention, retrieval, recall, visuospatial skills, occasional apraxia, as well as overt personality changes. Studies have shown dementia rates as high as 37-42% in older men with FXTAS, although more research is needed to understand the prevalence and risk factors of dementia in women with FXTAS. Neuropsychiatric symptoms are common and reflect the dysfunction of underlying frontal-subcortical neural circuits, along with components of the cerebellar cognitive affective syndrome. These include labile or depressed mood, anxiety, disinhibition, impulsivity, and (rarely) psychotic symptoms. In this paper we review the information available to date regarding the prevalence and clinical picture of FXTAS dementia. Differential diagnosis may be difficult, given overlapping motor and non-motor signs with several other neurodegenerative diseases. Anecdotal response to cholinesterase inhibitors and memantine has been reported, while symptomatic treatments can address the neuropsychiatric manifestations of FXTAS dementia. PMID:25620901

Seritan, Andreea; Cogswell, Jennifer; Grigsby, Jim

2015-01-01

349

Pelvic floor and sexual male dysfunction.  

PubMed

The pelvic floor is a complex multifunctional structure that corresponds to the genito-urinary-anal area and consists of muscle and connective tissue. It supports the urinary, fecal, sexual and reproductive functions and pelvic statics. The symptoms caused by pelvic floor dysfunction often affect the quality of life of those who are afflicted, worsening significantly more aspects of daily life. In fact, in addition to providing support to the pelvic organs, the deep floor muscles support urinary continence and intestinal emptying whereas the superficial floor muscles are involved in the mechanism of erection and ejaculation. So, conditions of muscle hypotonia or hypertonicity may affect the efficiency of the pelvic floor, altering both the functionality of the deep and superficial floor muscles. In this evolution of knowledge it is possible imagine how the rehabilitation techniques of pelvic floor muscles, if altered and able to support a voiding or evacuative or sexual dysfunction, may have a role in improving the health and the quality of life. PMID:23695397

Pischedda, Antonella; Fusco, Ferdinando; Curreli, Andrea; Grimaldi, Giovanni; Pirozzi Farina, Furio

2013-03-01

350

Analysis of platelet function and dysfunction.  

PubMed

Although platelets act as central players of haemostasis only their cross-talk with other blood cells, plasma factors and the vascular compartment enables the formation of a stable thrombus. Multiple activation processes and complex signalling networks are responsible for appropriate platelet function. Thus, a variety of platelet function tests are available for platelet research and diagnosis of platelet dysfunction. However, universal platelet function tests that are sensitive to all platelet function defects do not exist and therefore diagnostic algorithms for suspected platelet function disorders are still recommended in clinical practice. Based on the current knowledge of human platelet activation this review evaluates point-of-care related screening tests in comparison with specific platelet function assays and focuses on their diagnostic utility in relation to severity of platelet dysfunction. Further, systems biology-based platelet function methods that integrate global and specific analysis of platelet vessel wall interaction (advanced flow chamber devices) and post-translational modifications (platelet proteomics) are presented and their diagnostic potential is addressed. PMID:25482925

Jurk, K

2015-02-10

351

Pulmonary particulate matter and systemic microvascular dysfunction.  

PubMed

Pulmonary particulate matter (PM) exposure has been epidemiologically associated with an increased risk of cardiovascular morbidity and mortality, but the mechanistic foundations for this association are unclear. Exposure to certain types of PM causes changes in the vascular reactivity of several macrovascular segments. However, no studies have focused upon the systemic microcirculation, which is the primary site for the development of peripheral resistance and, typically, the site of origin for numerous pathologies. Ultrafine PM--also referred to as nanoparticles, which are defined as ambient and engineered particles with at least one physical dimension less than 100 nm (Oberdorster et al. 2005)--has been suggested to be more toxic than its larger counterparts by virtue of a larger surface area per unit mass. The purpose of this study was fourfold: (1) determine whether particle size affects the severity of postexposure microvascular dysfunction; (2) characterize alterations in microvascular nitric oxide (NO) production after PM exposure; (3) determine whether alterations in microvascular oxidative stress are associated with NO production, arteriolar dysfunction, or both; and (4) determine whether circulating inflammatory mediators, leukocytes, neurologic mechanisms, or a combination of these play a fundamental role in mediating pulmonary PM exposure and peripheral microvascular dysfunction. To achieve these goals, we created an inhalation chamber that generates stable titanium dioxide (TiO2) aerosols at concentrations up to 20 mg/m3. TiO2 is a well-characterized particle devoid of soluble metals. Sprague Dawley and Fischer 344 (F-344) rats were exposed to fine or nano-TiO2 PM (primary count modes of approximately 710 nm and approximately 100 nm in diameter, respectively) at concentrations of 1.5 to 16 mg/m3 for 4 to 12 hours to produce pulmonary loads of 7 to 150 microg in each rat. Twenty-four hours after pulmonary exposure, the following procedures were performed: the spinotrapezius muscle was prepared for in vivo microscopy, blood samples were taken from an arterial line, and various tissues were harvested for histologic and immunohistochemical analyses. Some rats received a bolus dose of cyclophosphamide 3 days prior to PM exposure to deplete circulating neutrophils and bronchoalveolar lavage (BAL) was performed in separate groups of rats exposed to identical TiO2 loads. No significant differences in BAL fluid composition based on PM size or load were found in these rats. Plasma levels of interleukin (IL)-2, IL-18, IL-13, and growth-related oncogene (GRO) (also known as keratinocyte-derived-chemokine [KC]) were altered after PM exposure. In rats exposed to fine TiO2, endothelium-dependent arteriolar dilation was significantly decreased, and this dysfunction was robustly augmented in rats exposed to nano-TiO2. This effect was not related to an altered smooth-muscle responsiveness to NO because arterioles in both groups dilated comparably in response to the NO donor sodium nitroprusside (SNP). Endogenous microvascular NO production was similarly decreased after inhalation of either fine or nano-TiO2 in a dose-dependent manner. Microvascular oxidative stress was significantly increased among both exposure groups. Furthermore, treatment with antioxidants (2,2,6,6-tetramethylpiperdine-N-oxyl [TEMPOL] plus catalase), the myeloperoxidase (MPO) inhibitor 4-aminobenzoic hydrazide (ABAH), or the nicotinamide adenine dinucleotide phosphate oxidase (NADPH oxidase) inhibitor apocynin partially restored NO production and normalized arteriolar function in both groups. Neutrophil depletion restored dilation in PM-exposed rats by as much as 42%. Coincubation of the spinotrapezius muscle with the fast sodium (Na+) channel antagonist tetrodotoxin (TTX) restored arteriolar dilation by as much as 54%, suggesting that sympathetic neural input may be affected by PM exposure. The results of these experiments indicate that (1) the size of inhaled PM dictates the intensity of systemic microvascular dysfunction; (2) this arteriolar dysfuncti

Nurkiewicz, Timothy R; Porter, Dale W; Hubbs, Ann F; Stone, Samuel; Moseley, Amy M; Cumpston, Jared L; Goodwill, Adam G; Frisbee, Stephanie J; Perrotta, Peter L; Brock, Robert W; Frisbee, Jefferson C; Boegehold, Matthew A; Frazer, David G; Chen, Bean T; Castranova, Vincent

2011-12-01

352

Localization of Autonomic Nervous System Dysfunction in Dialysis Patients  

Microsoft Academic Search

Autonomic nervous system dysfunction has been described frequently in uremic patients. The purpose of this study is to determine the localization of this abnormality and to study the possible relationship between autonomic dysfunction and the occurrence of dialysis hypotension. Sixteen consecutive patients participated in the study, 5 of whom had a history of dialysis-induced hypotension. These 5 patients were compared

Yoshiyuki Nakashima; Fetnat M. Fouad; Satoru Nakamoto; Stephen C. Textor; Emmanuel L. Bravo; Robert C. Tarazi

1987-01-01

353

Telomere dysfunction provokes regional amplification and deletion in cancer genomes  

Microsoft Academic Search

Telomere dysfunction and associated fusion-breakage in the mouse encourages epithelial carcinogenesis and a more humanized genomic profile that includes nonreciprocal translocations (NRTs). Here, array comparative genomic hybridization was used to determine the pathogenic significance of NRTs and to determine whether telomere dysfunction also drives amplifications and deletions of cancer-relevant loci. Compared to tumors arising in mice with intact telomeres, tumors

Rónán C. O'Hagan; Sandy Chang; Richard S. Maser; Ramya Mohan; Steven E. Artandi; Lynda Chin; Ronald A. DePinho

2002-01-01

354

Predicting Cognitive Dysfunctioning in Nondemented Patients Early after Stroke  

Microsoft Academic Search

Background: Cognitive dysfunctioning (CDF) is an important issue in stroke, interfering with recovery and social dysfunctioning. We aimed to investigate the clinical and imaging correlates of CDF in patients with a first-ever subacute ischemic stroke and no dementia. Methods: We evaluated CDF 15 days after stroke in a prospective cohort of consecutive patients with a Mini Mental State Examination score

Assia Jaillard; Sylvie Grand; Jean François Le Bas; Marc Hommel

2010-01-01

355

Disconnection as a Mechanism for Cognitive Dysfunction in Multiple Sclerosis  

ERIC Educational Resources Information Center

Disconnection of cognitively important processing regions by injury to the interconnecting white matter provides a potential mechanism for cognitive dysfunction in multiple sclerosis. The contribution of tract-specific white matter injury to dysfunction in different cognitive domains in patients with multiple sclerosis has not previously been…

Dineen, R. A.; Vilisaar, J.; Hlinka, J.; Bradshaw, C. M.; Morgan, P. S.; Constantinescu, C. S.; Auer, D. P.

2009-01-01

356

Microcirculatory dysfunction in sepsis: a pathogenetic basis for therapy?  

Microsoft Academic Search

Sepsis is a frequent complication of multiple organ dysfunction syndrome and remains a major problem of intensive care medicine. It is also a common factor in the final cause of death in hospital populations. Clinical observations, assisted by invasive monitoring techniques as well as pathological-anatomical studies, clearly indicate that microcirculatory dysfunction lies at the centre of sepsis pathogenesis. Numerous animal

Fernando Bittinger; C. James Kirkpatrick

2000-01-01

357

Psychological Dysfunction and Physical Health among Elderly Medical Inpatients.  

ERIC Educational Resources Information Center

Evaluated 150 geriatric medical inpatients for psychological dysfunction. Found 27.3 percent of subjects had at least one psychological disorder and 15.3 percent of total sample had a depressive disorder. Comorbid depression was associated with greatest level of psychological distress and dysfunction, and with poorest physical health status.…

Rapp, Stephen R.; And Others

1988-01-01

358

Horse species symposium pathogenic and reproductive dysfunction in hourses  

Technology Transfer Automated Retrieval System (TEKTRAN)

One of the major factors contributing to production losses in the equine industry is pathogen-associated reproductive dysfunction. Although it is difficult to place a true value on the economic losses associated with pathogen-induced reproductive dysfunction in the horse due to the varying value of ...

359

Corollary Discharge Dysfunction in Schizophrenia: Evidence for an Elemental Deficit  

Microsoft Academic Search

Evidence is accumulating that schizophrenia is characterized by dysfunction of efference copy\\/corollary discharge mechanisms that normally allow us to unconsciously recognize and disregard sensations resulting from our own actions. This dysfunction may give rise to subtle but pervasive sensory\\/perceptual aberrations in schizophrenic patients, altering their experience of their own overt and covert actions, as well as their interactions with the

Daniel H. Mathalon; Judith M. Ford

2008-01-01

360

Digit memory test: Unequivocal cerebral dysfunction and suspected malingering  

Microsoft Academic Search

The Digit Memory Test (DMT) (Hiscock & Hiscock, 1989), a forced-choice test for detecting malingering, was administered to 27 patients with unequivocal cerebral dysfunction, 5 patients with postconcussional syndrome, 6 suspected malingerers and 10 normal controls. Results indicate that, even in patients with severe, but static cerebral dysfunction and unequivocal memory disorder, DMT performance is between 95% to 100% correct.

George P. Prigatano; Kiran Amin

1993-01-01

361

Stroke: Bowel Dysfunction in Patients Admitted for Rehabilitation§  

PubMed Central

Aim : to assess the prevalence of diminished frequency of bowel movements, lumpy or hard stools, intestinal constipation, straining, incomplete evacuation, incontinence (bowel dysfunctions) in patients with brain injury resulting from cerebrovascular accident, either self-reported or reported by their caregivers; to describe the type and frequency of such dysfunctions; and the prevalence of laxative use both before and after stroke. Method : cross-sectional study with 98 hospitalized patients admitted for rehabilitation between December 2009 and May 2010. Results : the prevalence of bowel dysfunctions before stroke was 23.96% whereas after the lesion it was 55.21% (p<0.0001). As reported by patients/caregivers, the chances of developing bowel dysfunctions increase sevenfold after stroke, 95% CI (2.44-24.26). The most frequent dysfunctions before stroke were intestinal constipation (73.91%) and diminished frequency of bowel movements (17.39%). After stroke, constipation remains to be the most frequent dysfunction reported (50%), followed by diminished frequency of bowel movements (26.79%), incomplete evacuation (12.50%), and lack of privacy (5.36%). The use of laxatives was 19,15% after the lesion, but not statisticaly significant (p=0.0736). Conclusion : Bowel dysfunctions increases significantly after stroke. Therefore, further studies are needed to better understand and characterize such dysfunctions, which are scarcely described in the literature. PMID:25419252

Engler, Tânia M.N. de M; Dourado, Cinthia C; Amâncio, Thais G; Farage, Luciano; de Mello, Paulo A.; Padula, Marcele P.C

2014-01-01

362

URODYNAMIC CHARACTERIZATION OF NONOBSTRUCTIVE VOIDING DYSFUNCTION IN SYMPTOMATIC ELDERLY MEN  

Microsoft Academic Search

PurposeThe pathogenesis of lower urinary tract symptoms in men without bladder outlet obstruction has not been well characterized. Therefore, we defined the urodynamic abnormalities associated with symptomatic nonobstructive voiding dysfunction, and determined the relationship between age and type of dysfunction.

KANAME AMEDA; MARYROSE P. SULLIVAN; ROBERT J. BAE; SUBBARAO V. YALLA

1999-01-01

363

Uncoupled Cardiac Nitric Oxide Synthase Mediates Diastolic Dysfunction  

PubMed Central

Background Heart failure with preserved ejection fraction is one consequence of hypertension and caused by impaired cardiac diastolic relaxation. Nitric oxide (NO) is a known modulator of cardiac relaxation. Hypertension can lead to a reduction in vascular NO, in part because nitric oxide synthase (NOS) becomes uncoupled when oxidative depletion of its co-factor tetrahydrobiopterin (BH4) occurs.Similar events may occur in the heart leading to uncoupled NOS and diastolic dysfunction. Methods and Results In a hypertensive mouse model, diastolic dysfunction was accompanied by cardiac oxidation, a reduction in cardiac BH4, and uncoupled NOS. Compared to sham-operated animals, male mice with unilateral nephrectomy, with subcutaneous implantation of a controlled release deoxycorticosterone acetate (DOCA) pellet, and given 1% saline to drink were mildly hypertensive and had diastolic dysfunction in the absence of systolic dysfunction or cardiac hypertrophy. The hypertensive mouse hearts showed increased oxidized biopterins, NOS-dependent superoxide production, reduced NO production, and phosphorylated phospholamban. Feeding hypertensive mice BH4 (5 mg/day), but not treating with hydralazine or tetrahydroneopterin, improved cardiac BH4 stores, phosphorylated phospholamban levels, and diastolic dysfunction. Isolated cardiomyocyte experiments revealed impaired relaxation that was normalized with acute BH4 treatment. Targeted cardiac overexpression of angiotensin converting enzyme also resulted in cardiac oxidation, NOS uncoupling, and diastolic dysfunction in the absence of hypertension. Conclusions Cardiac oxidation, independent of vascular changes, can lead to uncoupled cardiac NOS and diastolic dysfunction. BH4 may represent a possible treatment for diastolic dysfunction. PMID:20083682

Silberman, Gad A.; Fan, Tai-Hwang M.; Liu, Hong; Jiao, Zhe; Xiao, Hong D.; Lovelock, Joshua D.; Boulden, Beth M.; Widder, Julian; Fredd, Scott; Bernstein, Kenneth E.; Wolska, Beata M.; Dikalov, Sergey; Harrison, David G.; Dudley, Samuel C.

2010-01-01

364

Gastric and lower esophageal sphincter pressures during nausea: a study using visual motion-induced nausea and high-resolution manometry.  

PubMed

Nausea is the subjective unpleasant sensation that immediately precedes vomiting. Studies using barostats suggest that gastric fundus and lower esophageal sphincter (LES) relaxation precede vomiting. Unlike barostat, high-resolution manometry allows less invasive, detailed measurements of fundus pressure (FP) and axial movement of the gastroesophageal junction (GEJ). Nausea was induced in 12 healthy volunteers by a motion video and rated on a visual analog scale. FP was measured as the mean value of the five pressure channels that were clearly positioned below the LES. After intubation, a baseline (BL) recording of 15 min was obtained. This was followed by presentation of the motion video (at least 10 min, maximum 20 min) followed by 30 min recovery recording. Throughout the experiment we recorded autonomic nervous system (ANS) parameters [blood pressure, heart rate (HR), and cardiac vagal tone (CVT), which reflects efferent vagal activity]. Ten out of 12 subjects showed a drop in FP during peak nausea compared with BL (-4.0 ± 0.8 mmHg; P = 0.005), and 8/10 subjects showed a drop in LES pressure (-8.8 ± 2.5 mmHg; P = 0.04). Peak nausea preceded peak fundus and LES pressure drop. Nausea was associated with configuration changes at the GEJ such as LES shortening and esophageal lengthening. During nausea we observed a significantly increased HR and decreased CVT. In conclusion, nausea is associated with a drop in fundus and LES pressure, configuration changes at the GEJ as well as changes in the ANS activity such as an increased sympathetic tone (increased HR) and decreased parasympathetic tone (decreased CVT). PMID:24627564

Schaub, Nora; Ng, Kee; Kuo, Paul; Aziz, Qasim; Sifrim, Daniel

2014-05-01

365

Changing associations of episiotomy and anal sphincter injury across risk strata: results of a population-based register study in Finland 2004–2011  

PubMed Central

Objectives To evaluate the changing association between lateral episiotomy and obstetric anal sphincter injury (OASIS) for women with low and high baseline risk of OASIS. Design A population-based register study. Setting Data gathered from the Finnish Medical Birth Register for the years 2004?2011. Participants All women with spontaneous vaginal or vacuum-assisted singleton births in Finland (n=384?638). Main outcome measure OASIS incidence. Results During the study period, the incidence of OASIS increased from 1.3% to 1.7% in women with first vaginal births, including women admitted for first vaginal birth after a prior caesarean section and from 0.1% to 0.3% in women with at least one prior birth, whereas episiotomy rates declined from 56.7% to 45.5% and 10.1– 5.3%, respectively. At the study onset, when episiotomy was used more widely, it was negatively associated with OASIS in women with first vaginal births, but as episiotomy use declined it became positively associated with OASIS. Women with episiotomy were complicated by OASIS with clearly higher risk scores than women without episiotomy suggesting that episiotomy was clearly protective against OASIS. OASIS occurred with lower mean risk scores among women with and without episiotomy over time. However, OASIS incidences increased only among women with episiotomy, whereas it decreased or remained among women without episiotomy. Conclusions The cross-over effect between episiotomy and OASIS could be explained by increasing disparity in baseline OASIS risk between treated and untreated women, since episiotomy use declined most in women at low OASIS risk. Episiotomy rate can be safely reduced in low-risk women but interestingly along with the policy change the practice to cut the episiotomy became less protective among high-risk women. PMID:23955189

Räisänen, Sari; Cartwright, Rufus; Gissler, Mika; Kramer, Michael R; Laine, Katariina; Jouhki, Maija-Riitta; Heinonen, Seppo

2013-01-01

366

The effect of guanylate cyclase inhibitors on non-adrenergic and non-cholinergic neurogenic relaxations of the South American opossum lower esophageal sphincter.  

PubMed

South American (SA) opossum lower esophageal sphincter (LES) circular smooth muscle relaxes by activation of enteric nerves elicited by EFS (electrical field stimulation, 0.5 ms, 48 V, 0.5-8 Hz for 10 s). The identity of the mediator released and the cellular mechanism, however, remain to be fully elucidated. The purpose of this study was to determine the effect of the enzyme soluble guanylate cyclase (cGC) inhibitors, cystamine (100 microM), methylene blue (30 microM), LY 83583 (6-anilino-5,8 quinoledione, 10 microM) and ODQ (H-[1,2,4]oxadiazolo[4,3]quinoxalin-1-one, 1 microM) on the relaxations induced by EFS and by exogenous NO (nitric oxide, 0.5 mM) or NO-donors on SA opossum LES smooth muscle strips. EFS caused frequency-dependent relaxations, which were inhibited by NO-synthase inhibitors and abolished by tetrodotoxin. Cystamine did not affect relaxations caused by EFS and NO or NO-donor. Methylene blue also failed to affect EFS-caused relaxations, although it was capable of inhibiting relaxation induced by NO. LY 83583 inhibited relaxations induced by NO, but did not affect those induced by EFS or by SNAP and HXA. ODQ abolished relaxations caused by EFS at lower frequencies and by HXA (hydroxylamine, 10 microM) and SNAP (S-nitroso-N-acetyl penicillamine, 10 microM). Relaxations at higher frequencies of EFS and induced by SNP (sodium nitroprusside, 30 microM) and NO were only reduced by ODQ. These findings indicate that activation of the cGC can be involved in relaxations induced by EFS at lower frequencies, but other mechanisms can be involved at higher frequencies of EFS and caused by SNP or NO. PMID:18485148

Matsuda, Nilce Mitiko; Lemos, Moysés Costa; Feitosa, Rui Libório

2008-06-01

367

Management of erectile dysfunction in hypertension: Tips and tricks  

PubMed Central

Arterial hypertension is a major risk factor for cardiovascular disease and affects approximately one third of the adult population worldwide. The vascular origin of erectile dysfunction is now widely accepted in the vast majority of cases. Erectile dysfunction is frequently encountered in patients with arterial hypertension and greatly affects their quality of life of hypertensive patients and their sexual partners. Therefore, the management of erectile dysfunction in hypertensive patients is of paramount importance. Unfortunately, erectile dysfunction remains under-reported, under-recognized, and under-treated in hypertensive patients, mainly due to the lack of familiarity with this clinical entity by treating physicians. This review aims to discuss the more frequent problems in the management of hypertensive patients with erectile dysfunction and propose ways to overcome these problems in everyday clinical practice. PMID:25276292

Viigimaa, Margus; Vlachopoulos, Charalambos; Lazaridis, Antonios; Doumas, Michael

2014-01-01

368

Commentary: Dopaminergic dysfunction in DYT1 dystonia  

PubMed Central

A three-base-pair deletion in the torsinA gene leads to generalized torsion dystonia (DYT1) in humans, an often devastating movement disorder in which voluntary movements are disrupted by sustained muscle spasms and abnormal limb posturing. In a recent issue of Experimental Neurology, Zhao et al. (2008) have provided a thorough behavioral, anatomic, and biochemical characterization of a mouse line that over-expresses human mutant torsinA, with particular emphasis on the possible role of dopaminergic dysfunction in these animals. This commentary provides an overview of the clinical and genetic features of the human disease and of the available transgenic mouse models for DYT1 dystonia, and discusses the evidence favoring the role of dopamine in the clinical manifestations of the disease. PMID:18513716

Wichmann, Thomas

2014-01-01

369

Sensory dysfunction in children who toe walk.  

PubMed

In order to formulate a hypothesis regarding the etiology of toe walking, the sensory processing abilities of 17 mentally retarded children who toe walk were examined. A galvanic skin response was used to compare reactions of the mentally retarded children and a group of normal children to a variety of sensory stimuli. Galvanic skin response testing did not reveal significant differences between the two groups in processing sensory input. Scores of the mentally retarded children from a postrotary nystagmus test were compared to values for normal children of the same age, and the results indicated that vestibular dysfunction was present in all of the subjects. We hypothesize that children may toe walk to increase somatosensory input to the lateral vestibular nucleus (Deiter's) and the lateral vestibulospinal tract to facilitate support tone in the lower extremities during walking. PMID:693578

Montgomery, P; Gauger, J

1978-10-01

370

Treatment of Angina and Microvascular Coronary Dysfunction  

PubMed Central

Opinion statement Microvascular coronary dysfunction (MCD) is an increasingly recognized cause of cardiac ischemia and angina, more commonly diagnosed in women. Patients with MCD present with the triad of persistent chest pain, ischemic changes on stress testing, and no obstructive coronary artery disease (CAD) on cardiac catheterization. Data from National Heart, Lung and Blood Institute (NHLBI)-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study has shown that the diagnosis of MCD is not benign, with a 2.5% annual risk of adverse cardiac events including myocardial infarction, stroke, congestive heart failure, or death. The gold standard diagnostic test for MCD is an invasive coronary reactivity test (CRT), which uses acetylcholine, adenosine, and nitroglycerin to test the endothelial dependent and independent, microvascular and macrovascular coronary function. The CRT allows for diagnostic and treatment options as well as further risk stratifying patients for future cardiovascular events. Treatment of angina and MCD should be aimed at ischemia disease management to reduce risk of adverse cardiac events, ameliorating symptoms to improve quality of life, and to decrease the morbidity from unnecessary and repeated cardiac catheterization in patients with open coronary arteries. A comprehensive treatment approach aimed at risk factor managment, including lifestyle counseling regarding smoking cessation, nutrition and physical activity should be initiated. Current pharmacotherapy for MCD can include the treatment of microvascular endothelial dysfunction (statins, angiotensin-converting enzyme inhibitor, low dose aspirin), as well as treatment for angina and myocardial ischemia (beta blockers, calcium channel blockers, nitrates, ranolazine). Additional symptom management techniques can include tri-cyclic medication, enhanced external counterpulsation, autogenic training, and spinal cord stimulation. While our current therapies are effective in the treatment of angina and MCD, large randomized outcome trials are needed to optimize strategies to improve morbidity and mortality. PMID:20842559

Samim, Arang; Nugent, Lynn; Mehta, Puja K.; Shufelt, Chrisandra; Merz, C. Noel Bairey

2014-01-01

371

Role of estrogen in diastolic dysfunction.  

PubMed

The prevalence of left ventricular diastolic dysfunction (LVDD) sharply increases in women after menopause and may lead to heart failure. While evidence suggests that estrogens protect the premenopausal heart from hypertension and ventricular remodeling, the specific mechanisms involved remain elusive. Moreover, whether there is a protective role of estrogens against cardiovascular disease, and specifically LVDD, continues to be controversial. Clinical and basic science have implicated activation of the renin-angiotensin-aldosterone system (RAAS), linked to the loss of ovarian estrogens, in the pathogenesis of postmenopausal diastolic dysfunction. As a consequence of increased tissue ANG II and low estrogen, a maladaptive nitric oxide synthase (NOS) system produces ROS that contribute to female sex-specific hypertensive heart disease. Recent insights from rodent models that mimic the cardiac phenotype of an estrogen-insufficient or -deficient woman (e.g., premature ovarian failure or postmenopausal), including the ovariectomized congenic mRen2.Lewis female rat, provide evidence showing that estrogen modulates the tissue RAAS and NOS system and related intracellular signaling pathways, in part via the membrane G protein-coupled receptor 30 (GPR30; also called G protein-coupled estrogen receptor 1). Complementing the cardiovascular research in this field, the echocardiographic correlates of LVDD as well as inherent limitations to its use in preclinical rodent studies will be briefly presented. Understanding the roles of estrogen and GPR30, their interactions with the local RAAS and NOS system, and the relationship of each of these to LVDD is necessary to identify new therapeutic targets and alternative treatments for diastolic heart failure that achieve the cardiovascular benefits of estrogen replacement without its side effects and contraindications. PMID:24414072

Zhao, Zhuo; Wang, Hao; Jessup, Jewell A; Lindsey, Sarah H; Chappell, Mark C; Groban, Leanne

2014-03-01

372

Right ventricular dysfunction in acute thermal injury.  

PubMed Central

The elevated cardiac output (CO) and pulmonary artery hypertension (PAH) observed in thermal injury offers a unique opportunity to study the effects of a combined pressure-flow load on the right ventricle in previously healthy persons. Potential responses include a diminished right ventricular ejection fraction (RVEF), increased right ventricular end-diastolic volume index (RVEDVI), and augmented myocardial oxygen consumption because of increased systolic wall tension. We investigated these factors in 15 nonhypoxic patients without sepsis having 15--75% body surface area burns using flow directed catheters and the thermodilution technique. All patients increased their CO in response in fluid resuscitation, but six patients with an elevated mean pulmonary artery pressure (greater than 20 mmHG and increased pulmonary vascular resistance (greater than 1.2 mmHg/min/L) had right ventricular dysfunction as evidenced by an increase (188 +/- 15 ml/M2) in RVEDVI and a decreased (0.26 +/- 4 ml/M2) RVEF. Patients without PAH had a smaller RVEDVI (115 +/- 4 ML/M2) and larger RVEF (0.39 +/- 0.02). Patients with PAH and RV dysfunction were older, had larger body surface area burns, lower systemic diastolic artery pressures (63 +/- 4 mmHg) and higher heart rates (114 +/- 7 beats/min); RV end-diastolic pressures were minimally elevated (9.5 +/- 1.4 mmHg). The decrease in RVEF and increase in RVEDVI may limit the hemodynamic response to fluid volume replacement and survival. Images Fig. 1. PMID:7362298

Martyn, J A; Snider, M T; Szyfelbein, S K; Burke, J F; Laver, M B

1980-01-01

373

Respiratory and Limb Muscle Dysfunction in COPD.  

PubMed

Abstract In the next decade, Chronic Obstructive Pulmonary Disease (COPD) will be a major leading cause of death worldwide. Impaired muscle function and mass are common systemic manifestations in COPD patients and negatively influence survival. Respiratory and limb muscles are usually affected in these patients, thus contributing to poor exercise tolerance and reduced quality of life (QoL). Muscles from the lower limbs are more severely affected than those of the upper limbs and the respiratory muscles. Several epidemiological features of COPD muscle dysfunction are being reviewed. Moreover, the most relevant etiologic factors and biological mechanisms contributing to impaired muscle function and mass loss in respiratory and limb muscles of COPD patients are also being discussed. Currently available therapeutic strategies such as different modalities of exercise training, neuromuscular electrical and magnetic stimulation, respiratory muscle training, pharmacological interventions, nutritional support, and lung volume reduction surgery are also being reviewed, all applied to COPD patients. We claim that body composition and quadriceps muscle strength should be routinely explored in COPD patients in clinical settings, even at early stages of their disease. Despite the progress achieved over the last decade in the description of this relevant systemic manifestation in COPD, much remains to be investigated. Further elucidation of the molecular mechanisms involved in muscle dysfunction, muscle mass loss and poor anabolism will help design novel therapeutic targets. Exercise and muscle training, alone or in combination with nutritional support, is undoubtedly the best treatment option to improve muscle mass and function and QoL in COPD patients. PMID:25438125

Barreiro, Esther; Gea, Joaquim

2014-12-01

374

Esophageal dysfunction in diabetes mellitus: is there a relation to clinical manifestation of neuropathy?  

Microsoft Academic Search

In a prospective study, we evaluated 33 diabetic patients [type I (n = 8) and type II (n = 25)]. Esophageal motor functions were examined by registering clinical symptoms and by performing esophageal manometry. We also investigated peripheral and autonomic neuropathy. In diabetics, the lower and upper esophageal sphincter pressure and amplitudes of peristaltic waves were reduced. Compared with controls

D. Hiippe; M. Tegenthoff; J. Faig; F. Brunke; S. Depka; M. Stuhldreier; G. Micklefield; A. Gillissen; B. May

1992-01-01

375

Arginase Inhibitor in the Pharmacological Correction of Endothelial Dysfunction  

PubMed Central

This paper is about a way of correction of endothelial dysfunction with the inhibitor of arginase: L-norvaline. There is an imbalance between vasoconstriction and vasodilatation factors of endothelium on the basis of endothelial dysfunction. Among vasodilatation agents, nitrogen oxide plays the basic role. Amino acid L-arginine serves as a source of molecules of nitrogen oxide in an organism. Because of the high activity of arginase enzyme which catalyzes the hydrolysis of L-arginine into ornithine and urea, the bioavailability of nitrogen oxide decreases. The inhibitors of arginase suppress the activity of the given enzyme, raising and production of nitrogen oxide, preventing the development of endothelial dysfunction. PMID:21747978

Pokrovskiy, Mihail V.; Korokin, Mihail V.; Tsepeleva, Svetlana A.; Pokrovskaya, Tatyana G.; Gureev, Vladimir V.; Konovalova, Elena A.; Gudyrev, Oleg S.; Kochkarov, Vladimir I.; Korokina, Liliya V.; Dudina, Eleonora N.; Babko, Anna V.; Terehova, Elena G.

2011-01-01

376

Personality changes in patients with vestibular dysfunction.  

PubMed

The vestibular system is a sensory system that has evolved to detect linear and angular acceleration of the head in all planes so that the brain is not predominantly reliant on visual information to determine self-motion. Since the vestibular system first evolved in invertebrate species in order to detect gravitational vertical, it is likely that the central nervous system has developed a special dependence upon vestibular input. In addition to the deficits in eye movement and postural reflexes that occur following vestibular dysfunction, there is convincing evidence that vestibular loss also causes cognitive and emotional disorders, some of which may be due to the reflexive deficits and some of which are related to the role that ascending vestibular pathways to the limbic system and neocortex play in the sense of spatial orientation. Beyond this, however, patients with vestibular disorders have been reported to experience other personality changes that suggest that vestibular sensation is implicated in the sense of self. These are depersonalization and derealization symptoms such as feeling "spaced out", "body feeling strange" and "not feeling in control of self". We propose in this review that these symptoms suggest that the vestibular system may make a unique contribution to the concept of self through information regarding self-motion and self-location that it transmits, albeit indirectly, to areas of the brain such as the temporo-parietal junction (TPJ). PMID:24194706

Smith, Paul F; Darlington, Cynthia L

2013-01-01

377

Endoplasmic reticulum dysfunction in Alzheimer's disease.  

PubMed

The endoplasmic reticulum (ER) serves many crucial cellular functions. However, when misfolded or unfolded proteins accumulated in the ER, the stress of ER will be induced. Meanwhile, the intracellular signaling network, which is called unfolded protein response, will also be activated to cope with. Those unfolded proteins can be recognized by three kinds of stress sensors which are IRE1, PERK, and ATF6. Based on lots of medical reports, ER stress in postmortem brains from Alzheimer's disease (AD) patients, animals, and vitro models have indicated that ER dysfunction might work as an important part in causing AD. In this review, we demonstrated that the effect of ER stress contributed to the pathogenesis of AD. ER stress associates almost the whole brain pathology processes which can be observed in AD, such as gene mutation of presenilin1, the abnormal clipped mRNA of presenilin2, ?-amyloid production, tau phosphorylation, and cell death. The status of ER stress and unfolded protein response in the pathogenesis of AD also suggests they can be used as potential therapeutic agents. PMID:24715417

Li, Jie-Qiong; Yu, Jin-Tai; Jiang, Teng; Tan, Lan

2015-02-01

378

Biomarkers of immune dysfunction in HIV  

PubMed Central

Purpose of review HIV infection is characterized by chronic immune system activation and inflammatory cytokine production. This review will highlight recent developments using plasma and cellular biomarkers of immune system activation and dysfunction to predict mortality and opportunistic disease in HIV-infected individuals. Recent findings HIV infection results in features characteristic of early aging of the immune system or ‘immune senescence’, driven by chronic antigen exposure and immune system activation. Microbial translocation of gut bacterial components is associated with chronic immune activation and possibly systemic inflammation. Antiretroviral therapy may not fully normalize this condition. Baseline elevations of certain biomarkers of inflammation or coagulopathy, notably interleukin-6 (IL-6), C-reactive protein (CRP), and d-dimer, have been associated with mortality or opportunistic disease, after adjustment for appropriate variables, in several large randomized clinical trials. It is not known if elevated IL-6 or CRP causes this morbidity and mortality or if they are simply surrogate markers of a global inflammatory state. Summary Several inflammatory biomarkers appear to add to our ability to predict mortality or opportunistic disease in HIV-infected individuals. Before biomarkers will be useful, it will be necessary to identify interventions that moderate biomarker levels, and then determine if this moderation attenuates disease outcomes. PMID:20978393

Nixon, Daniel E.; Landay, Alan L.

2010-01-01

379

Iron in neuronal function and dysfunction.  

PubMed

Iron (Fe) is an essential element for many metabolic processes, serving as a cofactor for heme and nonheme proteins. Cellular iron deficiency arrests cell growth and leads to cell death; however, like most transition metals, an excess of intracellular iron is toxic. The ability of Fe to accept and donate electrons can lead to the formation of reactive nitrogen and oxygen species, and oxidative damage to tissue components; contributing to disease and, perhaps, aging itself. It has also been suggested that iron-induced oxidative stress can play a key role in the pathogenesis of several neurodegenerative diseases. Iron progressively accumulates in the brain both during normal aging and neurodegenerative processes. However, iron accumulation occurs without the concomitant increase in tissue ferritin, which could increase the risk of oxidative stress. Moreover, high iron concentrations in the brain have been consistently observed in Alzheimer's disease (AD) and Parkinson's disease (PD). In this regard, metalloneurobiology has become extremely important in understanding the role of iron in the onset and progression of neurodegenerative diseases. Neurons have developed several protective mechanisms against oxidative stress, among them the activation of cellular signaling pathways. The final response will depend on the identity, intensity, and persistence of the oxidative insult. The characterization of the mechanisms involved in high iron induced in neuronal dysfunction and death is central to understanding the pathology of a number of neurodegenerative disorders. PMID:20232345

Salvador, Gabriela A

2010-01-01

380

Cytochrome c oxidase dysfunction in oxidative stress.  

PubMed

Cytochrome c oxidase (CcO) is the terminal oxidase of the mitochondrial electron transport chain. This bigenomic enzyme in mammals contains 13 subunits of which the 3 catalytic subunits are encoded by the mitochondrial genes. The remaining 10 subunits with suspected roles in the regulation, and/or assembly, are coded by the nuclear genome. The enzyme contains two heme groups (heme a and a3) and two Cu(2+) centers (Cu(2+) A and Cu(2+) B) as catalytic centers and handles more than 90% of molecular O(2) respired by the mammalian cells and tissues. CcO is a highly regulated enzyme which is believed to be the pacesetter for mitochondrial oxidative metabolism and ATP synthesis. The structure and function of the enzyme are affected in a wide variety of diseases including cancer, neurodegenerative diseases, myocardial ischemia/reperfusion, bone and skeletal diseases, and diabetes. Despite handling a high O(2) load the role of CcO in the production of reactive oxygen species still remains a subject of debate. However, a volume of evidence suggests that CcO dysfunction is invariably associated with increased mitochondrial reactive oxygen species production and cellular toxicity. In this paper we review the literature on mechanisms of multimodal regulation of CcO activity by a wide spectrum of physiological and pathological factors. We also review an array of literature on the direct or indirect roles of CcO in reactive oxygen species production. PMID:22841758

Srinivasan, Satish; Avadhani, Narayan G

2012-09-15

381

Early Mitochondrial Dysfunction after Cortical Contusion Injury  

PubMed Central

Abstract Following traumatic brain injury, mitochondria sustain structural and functional impairment, which contributes to secondary damage that can continue for days after the initial injury. The present study investigated mitochondrial bioenergetic changes in the rat neocortex at 1 and 3?h after mild, moderate, and severe injuries. Brains from young adult Sprague-Dawley rats were harvested from the injured and contralateral cortex to assess possible changes in mitochondrial respiration abilities following a unilateral cortical contusion injury. Differential centrifugation was used to isolate synaptic and extrasynaptic mitochondria from cortical tissue. Bioenergetics was assessed using a Clark-type electrode and results were graphed as a function of injury severity and time post-injury. Respiration was significantly affected by all injury severity levels compared to uninjured tissue. Complex 1- and complex 2-driven respirations were affected proportionally to the severity of the injury, indicating that damage to mitochondria may occur on a gradient. Total oxygen utilization, respiratory control ratio, ATP production, and maximal respiration capabilities were all significantly decreased in the injured cortex at both 1 and 3?h post-trauma. Although mitochondria displayed bioenergetic deficits at 1?h following injury, damage was not exacerbated by 3?h. This study stresses the importance of early therapeutic intervention and suggests a window of approximately 1–3?h before greater dysfunction occurs. PMID:19637966

Gilmer, Lesley K.; Roberts, Kelly N.; Joy, Kelly; Sullivan, Patrick G.

2009-01-01

382

Physiology of clinical dysfunction of the cerebellum.  

PubMed

Experimental and theoretical research into cerebellar function has begun to converge toward understanding the cerebellum as a "controller" in the engineering sense. The purpose of a controller is to convert high-level intent commands and information describing the current state of a system into low-level control signals suitable for maintaining or changing system behavior. The cerebellar subsystem appears to play this role for parts of the body and other parts of the brain. As with engineering controllers, fundamental functions include stabilization at a fixed posture or state, adjustment of movement or transition amplitude, facilitation of movement/transition speed and crispness of launch and braking, improvement of resistance to disturbances, coordination of control across multiple degrees of freedom, and assistance with estimation and/or prediction of current and future system states. As with adaptive engineering controllers, the cerebellar subsystem also readily tunes itself over time. At a more detailed level, many of the specific actions of cerebellar circuits can be understood in terms of proportional (P), integrator-like (I), and differentiator-like (D) signal processing which are fundamental components of many engineering control systems. This chapter presents an integrated, mechanistic view of ataxia, tremor, and several cerebellar oculomotor signs in terms of PID control and the neural centers that appear to subserve these functions. It also suggests the manner in which impairments in motor learning, perception, and cognition that are associated with cerebellar dysfunction may be viewed from a similar perspective. PMID:21827880

Massaquoi, Steve G

2012-01-01

383

Exercise, intestinal barrier dysfunction and probiotic supplementation.  

PubMed

Athletes exposed to high-intensity exercise show an increased occurrence of gastrointestinal (GI) symptoms like cramps, diarrhea, bloating, nausea, and bleeding. These problems have been associated with alterations in intestinal permeability and decreased gut barrier function. The increased GI permeability, a so-called 'leaky gut', also leads to endotoxemia, and results in increased susceptibility to infectious and autoimmune diseases, due to absorption of pathogens/toxins into tissue and the bloodstream. Key components that determine intestinal barrier function and GI permeability are tight junctions, protein structures located in the paracellular channels between epithelial cells of the intestinal wall. The integrity of tight junctions depends on sophisticated interactions between the gut residents and their expressed substances, the intestinal epithelial cell metabolism and the activities of the gut-associated lymphoid tissue. Probiotic supplements are an upcoming group of nutraceuticals that could offer positive effects on athlete's gut and entire health. Some results demonstrate promising benefits for probiotic use on the athlete's immune system. There is also evidence that probiotic supplementation can beneficially influence intestinal barrier integrity in acute diseases. With regard to exercise-induced GI permeability problems, there is still a lack of studies with appropriate data and a gap to understand the underlying mechanisms to support such health beneficial statements implicitly. This article refers (i) to exercise-induced intestinal barrier dysfunction, (ii) provides suggestions to estimate increased gut barrier permeability in athletes, and (iii) discusses the potential of probiotic supplementation to counteract an exercise-induced leaky gut. PMID:23075554

Lamprecht, Manfred; Frauwallner, Anita

2012-01-01

384

Cannabinoids: potential targets for bladder dysfunction.  

PubMed

Cannabinoids are the active chemical components of Cannabis sativa (marijuana). The medical use of cannabis goes back over 5,000 years. Cannabinoids produce a very wide array of central and peripheral effects, some of which may have beneficial clinical applications. The discovery of cannabinoid receptors has spawned great interest within the pharmaceutical industry with the hopes of capitalizing on the beneficial effects of cannabis without the unwanted psychotropic effects on the central and peripheral nervous system. This chapter presents an overview of the pharmacology of cannabinoids and their derivatives. It reviews the current literature on central and peripheral cannabinoid receptors as related to effects on the lower urinary tract and the role of these receptors in normal and abnormal urinary tract function. An objective evaluation of the published results of clinical trials of cannabis extracts for the treatment of bladder dysfunction resulting from multiple sclerosis is also presented. It is clear that cannabinoid receptors are present in the lower urinary tract as well as spinal and higher centers involved in lower urinary tract control. Systemic cannabinoids have effects on the lower urinary tract that may be able to become clinically useful; however, a much greater understanding of the mechanisms of cannabinoid receptors in control of the human lower urinary tract is necessary to facilitate development of novel cannabinoid drugs for treatment of pelvic disorders. PMID:21290238

Ruggieri, Michael R

2011-01-01

385

Emerging treatment options for meibomian gland dysfunction  

PubMed Central

Meibomian gland dysfunction (MGD) is one of the most common diseases observed in clinics; it influences a great number of people, and is the leading cause of evaporative dry eye. Given the increased recognition of the importance of MGD, a great amount of attention has been paid to therapies targeting this condition. The traditional treatments of MGD consist of warm compresses and lid hygiene for removing an obstructed meibum, as well as antibiotics and anti-inflammatory agents to improve the quality of the meibum. However, each of these treatments has a different shortcoming and the treatment of MGD remains challenging. Despite the numerous possible treatment options for MGD, it is still difficult to obtain complete relief of signs and symptoms. This review focuses on current emerging treatment options for MGD including intraductal meibomian gland probing, emulsion eye drops containing lipids, the LipiFlow® thermal pulsation system, N-acetyl-cysteine, azithromycin, oral supplementation with omega-3 essential fatty acids, and cyclosporine A. PMID:24043929

Qiao, Jing; Yan, Xiaoming

2013-01-01

386

Prison brain? Executive dysfunction in prisoners  

PubMed Central

A better understanding of the functioning of the brain, particularly executive functions, of the prison population could aid in reducing crime rates through the reduction of recidivism rates. Indeed, reoffending appears to be related to executive dysfunction and it is known that executive functions are crucial for self-regulation. In the current paper, studies to executive functions in regular adult prisoners compared to non-offender controls were reviewed. Seven studies were found. Specific executive functions were found to be impaired in the general prison population, i.e., attention and set-shifting, as well as in separate subgroups of violent (i.e., set-shifting and working memory) and non-violent offenders (i.e., inhibition, working memory and problem solving). We conclude that the limited number of studies is remarkable, considering the high impact of this population on society and elaborate on the implications of these specific impairments that were found. Further empirical research is suggested, measuring executive functioning within subjects over time for a group of detainees as well as a control group. PMID:25688221

Meijers, Jesse; Harte, Joke M.; Jonker, Frank A.; Meynen, Gerben

2015-01-01

387

The treatment of secondary orgasmic dysfunction II.  

PubMed

This study investigated the impact of group treatment on women with secondary orgasmic dysfunction and their partners. Eleven couples received 4 hours of basic sex education, after which seven of the couples received a Combination treatment format consisting of communication skills followed by sexual skills, while four of the couples received the opposite sequence. No significant differences were found between the two sequences. When compared with similarly recruited control couples in a previous study, a significantly greater number of treated women reached or exceeded the 50% criterion for coital orgasmic functioning after treatment. Couples who reported a better relationship adjustment prior to treatment reported a significantly greater gain in total sexual harmony than did less adjusted couples. Across the treatment conditions, women who had reached coital orgasm prior to treatment reported a significantly greater increase in relationship adjustment between the post-sex education and 6-month follow-up testing periods than women who had never reached coital orgasm. Some discrepancies in outcome were found in comparison with our earlier study, suggesting that subject heterogeneity may influence differential outcomes. PMID:3612828

Kilmann, P R; Milan, R J; Boland, J P; Mills, K H; Caid, C; Davidson, E; Bella, B; Wanlass, R; Sullivan, J; Montgomery, B

1987-01-01

388

Dysfunctions associated with dementia and their treatment.  

PubMed

International UnderstAID project shows the role of physiotherapist in patients with dementia as divided into two branches: helping to resolve the physical problems and solving the problems related to dementia. The role of physiotherapist in dementia treatment may be divided into two branches: helping to resolve the physical problems and solving the problems related to dementia. The physical problems consider such aspects as musculoskeletal disorders, mobility dysfunction and pain. Referring to musculoskeletal problems, the interventions of physical therapists should included whole-body progressive resistance exercise training, strengthening, "range-of-motion" and stretching exercises and transfer training. Mobility disorders are associated with physical symptoms such as: rigidity, balance problem, shuffling gait. Decreased mobility can be based on unrelieved pain. These are some crucial scales which are designed to detected the pain. For instance, The Pain Assessment in Advanced Dementia. Transcutaneous Electrical Nerve Stimulation, massage or exercises can be provide to reduce the pain in patients with dementia. Physiotherapy in dementia treatment influences not only physical functions but also the maintenance or progression of cognitive abilities of demented elderly subjects. PMID:25528921

Malak, Roksana; Kostiukow, Anna; Krawczyk-Wasielewska, Agnieszka; Keczmer, Przemek; Mojs, Ewa; G?odowska, Katarzyna; Samborski, W?odzimierz

2014-11-26

389

Diaphragm and ventilatory dysfunction during cancer cachexia.  

PubMed

Cancer cachexia is characterized by a continuous loss of locomotor skeletal muscle mass, which causes profound muscle weakness. If this atrophy and weakness also occurs in diaphragm muscle, it could lead to respiratory failure, which is a major cause of death in patients with cancer. Thus, the purpose of the current study was to determine whether colon-26 (C-26) cancer cachexia causes diaphragm muscle fiber atrophy and weakness and compromises ventilation. All diaphragm muscle fiber types were significantly atrophied in C-26 mice compared to controls, and the atrophy-related genes, atrogin-1 and MuRF1, significantly increased. Maximum isometric specific force of diaphragm strips, absolute maximal calcium activated force, and maximal specific calcium-activated force of permeabilized diaphragm fibers were all significantly decreased in C-26 mice compared to controls. Further, isotonic contractile properties of the diaphragm were affected to an even greater extent than isometric function. Ventilation measurements demonstrated that C-26 mice have a significantly lower tidal volume compared to controls under basal conditions and, unlike control mice, an inability to increase breathing frequency, tidal volume, and, thus, minute ventilation in response to a respiratory challenge. These data demonstrate that C-26 cancer cachexia causes profound respiratory muscle atrophy and weakness and ventilatory dysfunction. PMID:23515443

Roberts, Brandon M; Ahn, Bumsoo; Smuder, Ashley J; Al-Rajhi, Monsour; Gill, Luther C; Beharry, Adam W; Powers, Scott K; Fuller, David D; Ferreira, Leonardo F; Judge, Andrew R

2013-07-01

390

Executive dysfunction in subcortical ischaemic vascular disease  

PubMed Central

Background: Executive dysfunction has been reported in patients with subcortical-frontal pathology, even in the absence of dementia. Objective: This study was undertaken to determine if impairments in executive functioning could be found in non-demented patients with subcortical lacunes. Methods: Cross sectional comparison between older control subjects (n=27) and non-demented patients with one or more subcortical lacunes (n=12). All participants were administered a neuropsychological test battery incorporating three measures of executive functioning, the Stroop interference test, California card sorting test, and the initiation-perseveration subtest of the Mattis dementia rating scale. Results: No group differences were found on measures of recent verbal memory, language, or spatial ability. Normal controls performed better than patients with lacunes in visual memory. On the Stroop interference test, patients with lacunes performed as well as controls on the colour naming condition but slower on the interference condition. Patients with lacunes also generated fewer correct sorts on the California card sort test and achieved lower scores on the initiation-perseveration subtest. Executive measures were correlated with extent of white matter signal hyperintensity but not number of lacunes. Conclusion: Subcortical ischaemic vascular disease is associated with subtle declines in executive functioning and visual memory, even in non-demented patients. The pattern of cognitive impairment after subcortical lacunes is consistent with models of subcortical-frontal circuits. PMID:11796772

Kramer, J; Reed, B; Mungas, D; Weiner, M; Chui, H

2002-01-01

391

Postoperative cognitive dysfunction, Alzheimer's disease, and anesthesia.  

PubMed

Although aging itself is not a disease, there are many comorbidities that become more common with aging. Heart disease, cancer, and other chronic illnesses are either more common or more severe in aging patients. Approximately 5.5 million people in the United States have Alzheimer's disease (AD), with the principal risk factor being age. It is estimated that the incidence of AD diagnosis doubles every 5 years after the age of 65. Therefore, as the population ages, the impact of AD on the healthcare landscape will increase. Understanding how to manage patients with AD is critical as we begin to care for more elderly patients in the perioperative period. In addition to their other health considerations, aging surgical patients are increasingly more likely to have pre-existing AD or be at risk for developing AD. There is growing interest to determine how anesthesia affects the development or progression of AD. Similarly, a best practice for the anesthetic management of patients with AD is not yet defined. Finally, the relationship between AD and susceptibility to or exacerbation of postoperative cognitive dysfunction (POCD) is not well understood. In this review, we will discuss both the clinical and the preclinical data related to anesthesia and AD, describe the overlapping pathophysiology of neurodegeneration and provide some insight into the anesthetic care of patients with AD. PMID:23931049

Arora, Sona S; Gooch, Jennifer L; García, Paul S

2014-04-01

392

Auditory dysfunction associated with solvent exposure  

PubMed Central

Background A number of studies have demonstrated that solvents may induce auditory dysfunction. However, there is still little knowledge regarding the main signs and symptoms of solvent-induced hearing loss (SIHL). The aim of this research was to investigate the association between solvent exposure and adverse effects on peripheral and central auditory functioning with a comprehensive audiological test battery. Methods Seventy-two solvent-exposed workers and 72 non-exposed workers were selected to participate in the study. The test battery comprised pure-tone audiometry (PTA), transient evoked otoacoustic emissions (TEOAE), Random Gap Detection (RGD) and Hearing-in-Noise test (HINT). Results Solvent-exposed subjects presented with poorer mean test results than non-exposed subjects. A bivariate and multivariate linear regression model analysis was performed. One model for each auditory outcome (PTA, TEOAE, RGD and HINT) was independently constructed. For all of the models solvent exposure was significantly associated with the auditory outcome. Age also appeared significantly associated with some auditory outcomes. Conclusions This study provides further evidence of the possible adverse effect of solvents on the peripheral and central auditory functioning. A discussion of these effects and the utility of selected hearing tests to assess SIHL is addressed. PMID:23324255

2013-01-01

393

Drugs used to treat erectile dysfunction.  

PubMed

Knowledge of the drugs currently approved to treat erectile dysfunction (ED) is important for nurses who care for male patients, especially those men of middle age or older and those who have concurrent health problems or are taking medications that may contribute to ED. This article provides a very basic look at ED and the drugs currently approved and used for treatment. Informed nurses can increase patient understanding of ED, make suggestions for necessary referrals, and help patients and their sexual partners understand the appropriate use and cautions associated with drugs used to treat ED. On the surface, one might question why orthopaedic nurses would need knowledge about drugs currently used to treat ED. However, when one considers that a large proportion of patients in any orthopaedic setting are men, the need for knowledge about the use and safety of these medications becomes a valid component of total patient care. This is an especially important subject today, when media advertising has heightened public awareness of the medications used to treat ED but has not provided much toward a basic understanding about ED or the safe use of the advertised therapeutic agents. Nurses who have some knowledge about ED and the medications used to treat ED are better able to serve as a patient resource for education and referral. PMID:18521039

Turkoski, Beatrice B

2008-01-01

394

[Dysfunctions of biological clocks and their treatments].  

PubMed

Biological rhythms are periodic phenomena entrained to environmental changes by exogenous factors called synchronizers or entraining agents namely the light-dark cycle, the rest-activity cycle and the seasons, among others. In humans the major synchronizers are the light-dark and rest activity cycles. The endogenous component of a biological rhythm is dependent upon a number of clock genes. The main biological clock (oscillator or pacemaker) is the suprachiasmatic nucleus (SCN) of the anterior hypothalamus. The photoperiod (light-dark cycle) perceived by the retina acts on the SCN genes. Peripheral clocks have also been described in a number of tissues e.g. retina, adrenals. In a number of occurrences the synchronizers are badly perceived (transmeridian flights, shiftwork, nightwork...) or are not at all perceived (blindness). This situation is named rhythm desynchronization, it is external when the desynchronization is strictly related to the environment or internal when it is related to a dysfunction of the clock like in e.g. aging, Alzheimer disease, seasonal affective disorders (SAD) or hormone-dependent cancers which results in fatigue, sleep and mood disorders... A number of drugs called resynchronizing agents or chronobiotics which act on the biological clock are able to resynchronize the clock and to improve the patients' condition. Bright light is used in the treatment of SAD, melatonin, the pineal hormone, is also of interest when administered at precise timings in the 24hours scale. Other drugs like B12 vitamin or psychotropic drugs have also been proposed as chronobiotics. PMID:18706343

Touitou, Y

2008-06-01

395

Personality changes in patients with vestibular dysfunction  

PubMed Central

The vestibular system is a sensory system that has evolved to detect linear and angular acceleration of the head in all planes so that the brain is not predominantly reliant on visual information to determine self-motion. Since the vestibular system first evolved in invertebrate species in order to detect gravitational vertical, it is likely that the central nervous system has developed a special dependence upon vestibular input. In addition to the deficits in eye movement and postural reflexes that occur following vestibular dysfunction, there is convincing evidence that vestibular loss also causes cognitive and emotional disorders, some of which may be due to the reflexive deficits and some of which are related to the role that ascending vestibular pathways to the limbic system and neocortex play in the sense of spatial orientation. Beyond this, however, patients with vestibular disorders have been reported to experience other personality changes that suggest that vestibular sensation is implicated in the sense of self. These are depersonalization and derealization symptoms such as feeling “spaced out”, “body feeling strange” and “not feeling in control of self”. We propose in this review that these symptoms suggest that the vestibular system may make a unique contribution to the concept of self through information regarding self-motion and self-location that it transmits, albeit indirectly, to areas of the brain such as the temporo-parietal junction (TPJ). PMID:24194706

Smith, Paul F.; Darlington, Cynthia L.

2013-01-01

396

Endothelial barrier dysfunction in septic shock.  

PubMed

The endothelium provides an essential and selective membrane barrier that regulates the movement of water, solutes, gases, macromolecules and the cellular elements of the blood from the tissue compartment in health and disease. Its structure and continuous function is essential for life for all vertebrate organisms. Recent evidence indicates that the endothelial surface does not have a passive role in systemic inflammatory states such as septic shock. In fact, endothelial cells are in dynamic equilibrium with a myriad of inflammatory mediators and elements of the innate immune and coagulation systems to orchestrate the host response in sepsis. The barrier function of the endothelial surface is almost uniformly impaired in septic shock, and it is likely that this contributes to adverse outcomes. In this review, we will highlight recent advances in the understanding of the signaling events that regulate endothelial function and molecular events that induce endothelial dysfunction in sepsis. Endothelial barrier repair strategies as a treatment for sepsis include modulation of C5a, high-mobility group box 1 and VEGF receptor 2, stimulation of angiopoietin-1, sphingosine 1 phosphate receptor 1 and Slit and a number of other innovative approaches. This article is protected by copyright. All rights reserved. PMID:25418337

Opal, Steven M; van der Poll, Tom

2014-11-24

397

Combined photovacuum therapy of copulative dysfunction  

NASA Astrophysics Data System (ADS)

One of the important problems of modern medicine is treatment of urogenital diseases. 1-2 There is a set of the treatment methods for such problems, but any of them does not obey the modern physicians completely. 3-4 Our aim is to present the new combined therapeutic apparatus called "Yarovit" (produced in Russia, in collaboration between Bauman Moscow State University of Technology and Scientific Production Association and Medical Center "Yarovit") which successfully applied in clinics for cure the patients with copulative dysfunction diseases. 5-6 At this apparatus "Yarovit" (description model have abbreviation AMVL-0 1) there is a combination of vacuum decompression (0.1-0.4 kgs/cm2) and light emitting diodes matrix system (660 nm, 1-3 mW/cm2). In treatment procedure apparatus can be applied together with expanded module "Intratherm" (39 °C on average), which has rectal heating elements. The latest clinical studies were made together with volunteer participation of more then one hundred patients, and received results showed the good dynamic of healing. That let to conclude these combinations of physical therapeutic methods supplement each other and in conjunction provides a significant clinical effect. The further developments of such apparatuses are discussed.

Menyaev, Yulian A.; Zharov, Vladimir P.; Mishanin, Evgeniy A.; Kuzmich, Aleksandr P.; Bessonov, Sergey E.

2006-02-01

398

Long-term Outcomes of Tension-free Vaginal Tape Procedure for Treatment of Female Stress Urinary Incontinence with Intrinsic Sphincter Deficiency  

PubMed Central

Purpose To assess the long-term outcomes of tension-free vaginal tape (TVT) for stress urinary incontinence (SUI) with intrinsic sphincter deficiency (ISD) and to identify influencing factors for failure in these cases. Methods A total of 136 women who underwent TVT procedures with minimum follow-up duration of 3 years were included in the study. Patients were divided into two groups (non-ISD and ISD groups) based on preoperative urodynamic studies. Patient outcomes were assessed from retrospective chart review and telephone research. Cure was defined as the subjective resolution of SUI in any circumstances. Improvement was defined as the subjective improvement of SUI without complete resolution. Failure was defined as the subjective lack of improvement of SUI. Patients in ISD group were subdivided into two subgroups (cure and non-cure groups) and were compared to identify influencing factors for TVT procedure failure. Results Eighty-nine patients were in non-ISD group, and 47 in ISD group. The mean follow-up durations were 50.3±9.2 and 49.7±9.7 months, respectively. Subjective cure rate was 75.3% for non-ISD group, and 76.7% for ISD group (P>0.05). Improvement rate was 6.7% for non-ISD group, and 2.1% for ISD group (P>0.05). Satisfaction scores was 3.8±1.2 points in the non-ISD group, and 3.5±1.2 points in ISD group (P>0.05). In ISD subgroups, VLPP was 41.9±12.0 cmH2O for non-cure group, and 50.5±8.6 cmH2O for cure group, and was the only factor that showed significant statistical difference between the two subgroups (P=0.011). Conclusions With our long-term results, TVT is an effective treatment even in women with ISD. However, ISD patients with low VLPP should be counseled carefully about TVT outcome. PMID:22500254

Choo, Gwoan-Youb; Kim, Dae Hyun; Park, Hyoung Keun; Paick, Sung-Hyun; Lho, Yong-Soo

2012-01-01

399

Antidepressant-related sexual dysfunction - perspectives from neuroimaging.  

PubMed

Sexual dysfunction is not only a common symptom in major depression but also a frequent side-effect of antidepressant medication, mainly of the selective serotonin reuptake-inhibitors (SSRI) that are often prescribed as a first line treatment option. Despite of the increasing incidence and prescription rates, neuronal mechanisms underlying SSRI-related sexual dysfunction are poorly understood and investigations on this topic are scarce. Neuroimaging techniques, mainly functional magnetic resonance imaging (fMRI), provide a feasible approach to investigate these mechanisms since SSRI-related sexual dysfunction is most likely related to central nervous processes. This review summarizes the recent literature regarding the basic clinical findings and imaging correlates of antidepressant-related sexual dysfunction linking brain regions and networks potentially involved to phases and subcomponents of sexual processing and antidepressant action. In particular, fMRI studies on SSRI antidepressants including paroxetine and SNRIs including bupropion are highlighted. PMID:24333547

Graf, Heiko; Walter, Martin; Metzger, Coraline D; Abler, Birgit

2014-06-01

400

Hidden Risks of Erectile Dysfunction "Treatments" Sold Online  

MedlinePLUS

... Updates by E-mail Consumer Updates RSS Feed Hidden Risks of Erectile Dysfunction "Treatments" Sold Online Search ... and Border Protection to develop a more effective network to successfully screen and stop these shipments from ...

401

Learning Disabilities Due to Minimal Brain Dysfunction: Hope Through Research.  

ERIC Educational Resources Information Center

The pamphlet provides basic information on learning disabilities due to minimal brain dysfunction (MBD). Topics considered include terminology, incidence, symptoms, causes and prevention, diagnosis, family role for MBD children, and research in learning disabilities due to MBD. (CL)

National Inst. of Neurological and Communicative Disorders and Stroke (NIH), Bethesda, MD.

402

The relationship between connective tissue abnormality and pelvic floor dysfunction.  

E-print Network

??The University of Manchester, Doctor of Medicine, 2013Gemma FaulknerThe relationship between connective tissue abnormality and pelvic floor dysfunctionPerineal descent (PD) is a sign of connective… (more)

Faulkner, Gemma

2013-01-01

403

Development of quantitative tools for assessment of cerebellar dysfunction  

E-print Network

Two tools for the quantitative assessment of cerebellar dysfunction are developed and explored. One is based on a battery of laptop tests desgined for clinical use. Extensive analysis of one of the tests using a speed/accuracy ...

Garg, Aditi

2005-01-01

404

Anal function-preserving subtotal intersphincteric resection/partial external sphincteric resection with hybrid 2-port hand-assisted laparoscopic surgery (Mukai's operation) for very low stage I rectal cancer: A case report  

PubMed Central

A 62-year-old male patient underwent endoscopic mucosal resection (EMR). Additional hybrid 2-port hand-assisted laparoscopic surgery (HALS) (Mukai's operation) was performed for early rectal cancer located at the distal border of the rectum/below the peritoneal reflection (Rb) region [SM massive invasion/ly+/vertical margin (VM)X] via a small transverse incision, approximately 55 mm long, at the superior border of the pubic bone. After the pelvic floor muscles were dissected by laparoscopy-assisted manipulation, transanal subtotal intersphincteric resection (ISR) was performed under direct vision, securing a margin of more than 15 mm distal to the EMR scar. Partial external sphincteric resection (ESR) was also performed to obtain an adequate VM at the posterior region of the EMR scar. After bowel reconstruction, the layers were sutured transanally and a temporary covering colostomy was created. The resected specimen contained no residual tumor cells without lymph node metastasis. At 3 months after the operation, digital examination revealed good tonus of the anal muscles without stricture. The patient is currently undergoing rehabilitation of his anal sphincter muscles in preparation for the colostomy closure. In conclusion, subtotal ISR combined with partial ESR may decrease the need to perform Miles' operation for T1/2 stage I rectal cancer located at the distal border of the Rb region. PMID:22866130

Mukai, Masaya; Sekido, Yasutomo; Fukumitsu, Hiroshi; Izumi, Hideki; Hoshikawa, Tatsuhiko; Tajima, Takayuki; Tobita, Kousuke; Sadahiro, Sotaro; Yasuda, Seiei; Ogoshi, Kyoji

2011-01-01

405

Pharmacokinetics of micafungin in subjects with severe hepatic dysfunction.  

PubMed

Micafungin is an echinocandin with potent activity against a broad range of fungal species, including Candida species. The pharmacokinetic and safety profiles of micafungin have been evaluated in individuals with mild-to-moderate hepatic dysfunction, but not in individuals with severe hepatic dysfunction. Therefore, the present study assessed the pharmacokinetics and safety of a single 100 mg dose of micafungin in healthy subjects (n = 8) and subjects with severe hepatic dysfunction (n = 8). Mean maximum plasma concentration of micafungin and mean area under the plasma micafungin concentration-time curve extrapolated to infinity were lower in subjects with severe hepatic dysfunction (7.3 ± 2.4 µg/mL and 100.1 ± 34.5 h·?g/mL, respectively) than in subjects with normal hepatic function (10.3 ± 2.5 µg/mL and 142.4 ± 28.9?h·?g/mL, respectively). Mean clearance was higher in subjects with severe hepatic dysfunction (1,098 ± 347 mL/h) than in subjects with normal hepatic function (728 ± 149 mL/h). Concentrations of albumin in subjects with severe hepatic dysfunction were lower. Assessments of micafungin plasma protein binding suggested that the higher clearance in subjects with severe hepatic dysfunction may be due to higher unbound concentrations. However, the magnitude of the differences was not considered clinically meaningful and is comparable with exposures reported elsewhere for a 100-mg dose in patients treated for invasive candidiasis. Thus, dose adjustment in subjects with severe hepatic dysfunction is not warranted. Micafungin was well tolerated in all subjects throughout the study. PMID:24888485

Undre, Nasrullah; Pretorius, Benjamin; Stevenson, Paul

2014-06-01

406

Multi-organ Dysfunction Syndrome with Dual Organophosphate Pesticides Poisoning  

PubMed Central

Organophosphate (OP) pesticide self-poisoning is common in developing countries. Poisoning with dual OP compounds is rare. Multi-organ dysfunction after OP poisoning has a high mortality rate. We report the case of a 27-year-old man who developed multi-organ dysfunction syndrome with fatal outcome after intentional ingestion of 50:50 mixture of two OP compounds, dichlorvos and profenofos. PMID:24403738

Mishra, Ajay; Pandya, Himanshu V.; Dave, Nikhil; Mehta, Manan

2013-01-01

407

Obesity and Primary Graft Dysfunction after Lung Transplantation  

PubMed Central

Rationale: Obesity has been linked to acute lung injury and is a risk factor for early mortality after lung transplantation. Objectives: To examine the associations of obesity and plasma adipokines with the risk of primary graft dysfunction after lung transplantation. Methods: We performed a prospective cohort study of 512 adult lung transplant recipients with chronic obstructive pulmonary disease or interstitial lung disease enrolled in the Lung Transplant Outcomes Group Study. In a nested case-control study, we measured plasma leptin, adiponectin, and resistin before lung transplantation and 6 and 24 hours after lung transplantation in 40 cases of primary graft dysfunction and 80 control subjects. Generalized linear mixed models and logistic regression were used to estimate risk ratios and odds ratios. Measurements and Main Results: Grade 3 primary graft dysfunction developed within 72 hours of transplantation in 29% participants. Obesity was associated with a twofold increased risk of primary graft dysfunction (adjusted risk ratio 2.1; 95% confidence interval, 1.7–2.6). The risk of primary graft dysfunction increased by 40% (confidence interval, 30–50%) for each 5 kg/m2 increase in body mass index after accounting for center, diagnosis, cardiopulmonary bypass, and transplant procedure. Higher plasma leptin levels were associated with a greater risk of primary graft dysfunction (sex-adjusted P = 0.02). The associations of both obesity and leptin with primary graft dysfunction tended to be stronger among those who did not undergo cardiopulmonary bypass. Conclusions: Obesity is an independent risk factor for primary graft dysfunction after lung transplantation. PMID:21799077

Kawut, Steven M.; Wickersham, Nancy; Winterbottom, Christopher; Bhorade, Sangeeta; Palmer, Scott M.; Lee, James; Diamond, Joshua M.; Wille, Keith M.; Weinacker, Ann; Lama, Vibha N.; Crespo, Maria; Orens, Jonathan B.; Sonett, Joshua R.; Arcasoy, Selim M.; Ware, Lorraine B.; Christie, Jason D.

2011-01-01

408

Sexual dysfunction following operation for carcinoma of the rectum  

Microsoft Academic Search

In a retrospective study, sexual and urologic dysfunction were evaluated after a personal interview with 110 patients operated\\u000a upon for carcinoma of the rectum with a long observation period. Following abdominoperineal resection in 93 patients, sexual\\u000a dysfunction was found in 32 per cent, and 18 per cent were totally impotent. In 17 patients who had low anterior resections,\\u000a none became

Ib Balslev; Henrik Harling

1983-01-01

409

Psychiatric symptoms of noradrenergic dysfunction: a pathophysiological view.  

PubMed

What psychiatric symptoms are caused by central noradrenergic dysfunction? The hypothesis considered in this review is that noradrenergic dysfunction causes the abnormalities in arousal level observed in functional psychoses. In this review, the psychiatric symptoms of noradrenergic dysfunction were inferred pathophysiologically from the neuroscience literature. This inference was examined based on the literature on the biology of psychiatric disorders and psychotropics. Additionally, hypotheses were generated as to the cause of the noradrenergic dysfunction. The central noradrenaline system, like the peripheral system, mediates the alarm reaction during stress. Overactivity of the system increases the arousal level and amplifies the emotional reaction to stress, which could manifest as a cluster of symptoms, such as insomnia, anxiety, irritability, emotional instability and exaggerated fear or aggressiveness (hyperarousal symptoms). Underactivity of the system lowers the arousal level and attenuates the alarm reaction, which could result in hypersomnia and insensitivity to stress (hypoarousal symptoms). Clinical data support the hypothesis that, in functional psychoses, the noradrenergic dysfunction is in fact associated with the arousal symptoms described above. The anti-noradrenergic action of anxiolytics and antipsychotics can explain their sedative effects on the hyperarousal symptoms of these disorders. The results of animal experiments suggest that excessive stress can be a cause of long-term noradrenergic dysfunction. PMID:24372896

Yamamoto, Ken-ichi; Shinba, Toshikazu; Yoshii, Mitsunobu

2014-01-01

410

Prevalence of Musculoskeletal Dysfunctions among Indian Pregnant Women  

PubMed Central

Background and Objectives. Pregnancy triggers a wide range of changes in a woman's body leading to various musculoskeletal dysfunctions. Most commonly reported musculoskeletal discomforts by pregnant women are low back pain and symphysis pubis pain. The culture and the environmental factors may influence the discomforts experienced by a pregnant woman. There is a dearth of literature in India, regarding the common musculoskeletal dysfunctions experienced by a pregnant woman, and hence this study. Method. A questionnaire to identify the musculoskeletal dysfunction was developed; content was validated and was translated to local languages through parallel back translation. 261 primiparous pregnant women participated in the study and filled the questionnaire in their native language. Results. Among the musculoskeletal dysfunctions reported by the pregnant women, 64.6% reported calf muscle cramps, 37.1% reported foot pain, and 33.7% experienced low back pain in their third trimester. In the second trimester, common musculoskeletal dysfunctions experienced by the women were that of calf pain (47.8%), low back pain (42%), and pelvic girdle pain (37%). Conclusion. Musculoskeletal dysfunctions and general discomforts very commonly affect the activities of daily living of pregnant women. Understanding the common discomforts during various trimesters of pregnancy will help to develop a comprehensive program for prevention and cure. PMID:25642349

Maiya, Arun G.; Kumar, Pratap; Kamath, Asha

2015-01-01

411

Voiding dysfunction in young, nulliparous women: symptoms and urodynamic findings.  

PubMed

The objective was to determine urodynamic findings in young, premenopausal, nulliparous women with bothersome lower urinary tract symptoms and assess whether or not symptoms are predictive of specific urodynamic abnormalities. The records of 57 women were reviewed. Those with neurological disease or a primary complaint of stress incontinence were excluded. All completed the American Urological Association Symptom Index (AUASI) and underwent videourodynamics. Symptoms were compared in patients with and without bladder dysfunction and/or voiding phase dysfunction. Bladder dysfunction was diagnosed in 86% of patients with urge incontinence vs. 17% of those without (p<0.0001). Patients with voiding phase dysfunction had higher total and voiding AUASI scores. Occult neurological disease was later diagnosed in 4 women (24%) with urge incontinence and bladder dysfunction. Urge incontinence and voiding symptoms are frequently associated with urodynamically demonstrable abnormalities. Urge incontinence and bladder dysfunction may be a sign of occult neurological disease in this population. The presenting symptoms are useful in determining the utility of urodynamics in this population. PMID:15278258

Rosenblum, Nirit; Scarpero, Harriette M; Nitti, Victor W

2004-01-01

412

Male sexual dysfunction and HIV--a clinical perspective.  

PubMed

Sexual dysfunction in men with HIV is often overlooked by clinicians owing to many factors, including the taboo of sexuality. The improved life expectancy of patients with HIV requires physicians to consider their general wellbeing and sexual health with a renewed interest. However, data on sexual dysfunction in those with HIV are scarce. Erectile dysfunction (ED) is the most common sexual dysfunction in men, with a prevalence of ?30-50% and is frequent even in men <40 years of age. HIV infection itself is the strongest predictor of ED, and many factors related to the infection-fear of virus transmission, changes in body image, HIV-related comorbidities, infection stigma, obligatory condom use-all impair erectile function. The diagnosis and treatment of sexual dysfunction is based on a multidisciplinary approach, which involves specialists in both infectious diseases and sexual medicine. Particular attention should be paid to the promotion of safer sex in these patients. This Review, describes the issues surrounding sexual dysfunction in men with HIV and aims to provide clinical advice for the physician treating these patients. PMID:24394405

Santi, Daniele; Brigante, Giulia; Zona, Stefano; Guaraldi, Giovanni; Rochira, Vincenzo

2014-02-01

413

Scents and Nonsense: Olfactory Dysfunction in Schizophrenia  

PubMed Central

Among the sensory modalities, olfaction is most closely associated with the frontal and temporal brain regions that are implicated in schizophrenia and most intimately related to the affective and mnemonic functions that these regions subserve. Olfactory probes may therefore be ideal tools through which to assess the structural and functional integrity of the neural substrates that underlie disease-related cognitive and emotional disturbances. Perhaps more importantly, to the extent that early sensory afferents are also disrupted in schizophrenia, the olfactory system—owing to its strategic anatomic location—may be especially vulnerable to such disruption. Olfactory dysfunction may therefore be a sensitive indicator of schizophrenia pathology and may even serve as an “early warning” sign of disease vulnerability or onset. In this article, we review the evidence supporting a primary olfactory sensory disturbance in schizophrenia. Convergent data indicate that structural and functional abnormalities extend from the cortex to the most peripheral elements of the olfactory system. These reflect, in part, a genetically mediated neurodevelopmental etiology. Gross structural and functional anomalies are mirrored by cellular and molecular abnormalities that suggest decreased or faulty innervation and/or dysregulation of intracellular signaling. A unifying mechanistic hypothesis may be the epigenetic regulation of gene expression. With the opportunity to obtain olfactory neural tissue from live patients through nasal epithelial biopsy, the peripheral olfactory system offers a uniquely accessible window through which the pathophysiological antecedents and sequelae of schizophrenia may be observed. This could help to clarify underlying brain mechanisms and facilitate identification of clinically relevant biomarkers. PMID:19793796

Turetsky, Bruce I.; Hahn, Chang-Gyu; Borgmann-Winter, Karin; Moberg, Paul J.

2009-01-01

414

Dysfunctional dopaminergic neurotransmission in asocial BTBR mice.  

PubMed

Autism spectrum disorders (ASD) are neurodevelopmental conditions characterized by pronounced social and communication deficits and stereotyped behaviours. Recent psychosocial and neuroimaging studies have highlighted reward-processing deficits and reduced dopamine (DA) mesolimbic circuit reactivity in ASD patients. However, the neurobiological and molecular determinants of these deficits remain undetermined. Mouse models recapitulating ASD-like phenotypes could help generate hypotheses about the origin and neurophysiological underpinnings of clinically relevant traits. Here we used functional magnetic resonance imaging (fMRI), behavioural and molecular readouts to probe dopamine neurotransmission responsivity in BTBR T(+) Itpr3(tf)/J mice (BTBR), an inbred mouse line widely used to model ASD-like symptoms owing to its robust social and communication deficits, and high level of repetitive stereotyped behaviours. C57BL/6J (B6) mice were used as normosocial reference comparators. DA reuptake inhibition with GBR 12909 produced significant striatal DA release in both strains, but failed to elicit fMRI activation in widespread forebrain areas of BTBR mice, including mesolimbic reward and striatal terminals. In addition, BTBR mice exhibited no appreciable motor responses to GBR 12909. DA D1 receptor-dependent behavioural and signalling responses were found to be unaltered in BTBR mice, whereas dramatic reductions in pre- and postsynaptic DA D2 and adenosine A2A receptor function was observed in these animals. Overall these results document profoundly compromised DA D2-mediated neurotransmission in BTBR mice, a finding that is likely to have a role in the distinctive social and behavioural deficits exhibited by these mice. Our results call for a deeper investigation of the role of dopaminergic dysfunction in mouse lines exhibiting ASD-like phenotypes, and possibly in ASD patient populations. PMID:25136890

Squillace, M; Dodero, L; Federici, M; Migliarini, S; Errico, F; Napolitano, F; Krashia, P; Di Maio, A; Galbusera, A; Bifone, A; Scattoni, M L; Pasqualetti, M; Mercuri, N B; Usiello, A; Gozzi, A

2014-01-01

415

Idiopathic toe walking and sensory processing dysfunction  

PubMed Central

Background It is generally understood that toe walking involves the absence or limitation of heel strike in the contact phase of the gait cycle. Toe walking has been identified as a symptom of disease processes, trauma and/or neurogenic influences. When there is no obvious cause of the gait pattern, a diagnosis of idiopathic toe walking (ITW) is made. Although there has been limited research into the pathophysiology of ITW, there has been an increasing number of contemporary texts and practitioner debates proposing that this gait pattern is linked to a sensory processing dysfunction (SPD). The purpose of this paper is to examine the literature and provide a summary of what is known about the relationship between toe walking and SPD. Method Forty-nine articles were reviewed, predominantly sourced from peer reviewed journals. Five contemporary texts were also reviewed. The literature styles consisted of author opinion pieces, letters to the editor, clinical trials, case studies, classification studies, poster/conference abstracts and narrative literature reviews. Literature was assessed and graded according to level of evidence. Results Only one small prospective, descriptive study without control has been conducted in relation to idiopathic toe walking and sensory processing. A cross-sectional study into the prevalence of idiopathic toe walking proposed sensory processing as being a reason for the difference. A proposed link between ITW and sensory processing was found within four contemporary texts and one conference abstract. Conclusion Based on the limited conclusive evidence available, the relationship between ITW and sensory processing has not been confirmed. Given the limited number and types of studies together with the growing body of anecdotal evidence it is proposed that further investigation of this relationship would be advantageous. PMID:20712877

2010-01-01

416

Udenafil for the treatment of erectile dysfunction  

PubMed Central

Erectile dysfunction (ED) is often perceived by both patients and sexual partners as a serious problem that can jeopardize quality of life, psychosocial or emotional well-being, and the partnership in the long term. Since their introduction, oral phosphodiesterase type 5 inhibitors (PDE5Is) have been found to be highly effective and well tolerated, and are available as the first-line therapy for the treatment of ED. Udenafil is one of the selective PDE5Is made available in recent years for the treatment of ED. Udenafil has clinical properties of both relatively rapid onset and long duration of action due to its pharmacokinetic profile, thereby providing an additional treatment option for ED men to better suit individual needs. There is positive evidence that udenafil is effective and well tolerated in the treatment of ED of a broad spectrum of etiologies or severity. Udenafil is as effective in the treatment of diabetes mellitus-associated ED as other PDE5Is. Due to the clinical property of relatively long duration of action, udenafil may be another option in daily dosing treatment for ED, as suggested by its favorable efficacy and safety profile. Most adverse effects reported from clinical trials are mild or moderate in severity, without any serious adverse event, with headache and flushing being the most common. Also, the concomitant use of anti-hypertensive drugs or alpha-1-blockers does not significantly affect the efficacy and safety profile of udenafil. However, additional studies with larger cohorts including prospective, multicenter, comparative studies with patients of different ethnicities are needed to further validate the favorable findings of udenafil in the treatment of ED. PMID:24868160

Cho, Min Chul; Paick, Jae-Seung

2014-01-01

417

Hypercholesterolemia and microvascular dysfunction: interventional strategies.  

PubMed

Hypercholesterolemia is defined as excessively high plasma cholesterol levels, and is a strong risk factor for many negative cardiovascular events. Total cholesterol levels above 200 mg/dl have repeatedly been correlated as an independent risk factor for development of peripheral vascular (PVD) and coronary artery disease (CAD), and considerable attention has been directed toward evaluating mechanisms by which hypercholesterolemia may impact vascular outcomes; these include both results of direct cholesterol lowering therapies and alternative interventions for improving vascular function. With specific relevance to the microcirculation, it has been clearly demonstrated that evolution of hypercholesterolemia is associated with endothelial cell dysfunction, a near-complete abrogation in vascular nitric oxide bioavailability, elevated oxidant stress, and the creation of a strongly pro-inflammatory condition; symptoms which can culminate in profound impairments/alterations to vascular reactivity. Effective interventional treatments can be challenging as certain genetic risk factors simply cannot be ignored. However, some hypercholesterolemia treatment options that have become widely used, including pharmaceutical therapies which can decrease circulating cholesterol by preventing either its formation in the liver or its absorption in the intestine, also have pleiotropic effects with can directly improve peripheral vascular outcomes. While physical activity is known to decrease PVD/CAD risk factors, including obesity, psychological stress, impaired glycemic control, and hypertension, this will also increase circulating levels of high density lipoprotein and improving both cardiac and vascular function. This review will provide an overview of the mechanistic consequences of the predominant pharmaceutical interventions and chronic exercise to treat hypercholesterolemia through their impacts on chronic sub-acute inflammation, oxidative stress, and microvascular structure/function relationships. PMID:21087503

Stapleton, Phoebe A; Goodwill, Adam G; James, Milinda E; Brock, Robert W; Frisbee, Jefferson C

2010-01-01

418

Hypercholesterolemia and microvascular dysfunction: interventional strategies  

PubMed Central

Hypercholesterolemia is defined as excessively high plasma cholesterol levels, and is a strong risk factor for many negative cardiovascular events. Total cholesterol levels above 200 mg/dl have repeatedly been correlated as an independent risk factor for development of peripheral vascular (PVD) and coronary artery disease (CAD), and considerable attention has been directed toward evaluating mechanisms by which hypercholesterolemia may impact vascular outcomes; these include both results of direct cholesterol lowering therapies and alternative interventions for improving vascular function. With specific relevance to the microcirculation, it has been clearly demonstrated that evolution of hypercholesterolemia is associated with endothelial cell dysfunction, a near-complete abrogation in vascular nitric oxide bioavailability, elevated oxidant stress, and the creation of a strongly pro-inflammatory condition; symptoms which can culminate in profound impairments/alterations to vascular reactivity. Effective interventional treatments can be challenging as certain genetic risk factors simply cannot be ignored. However, some hypercholesterolemia treatment options that have become widely used, including pharmaceutical therapies which can decrease circulating cholesterol by preventing either its formation in the liver or its absorption in the intestine, also have pleiotropic effects with can directly improve peripheral vascular outcomes. While physical activity is known to decrease PVD/CAD risk factors, including obesity, psychological stress, impaired glycemic control, and hypertension, this will also increase circulating levels of high density lipoprotein and improving both cardiac and vascular function. This review will provide an overview of the mechanistic consequences of the predominant pharmaceutical interventions and chronic exercise to treat hypercholesterolemia through their impacts on chronic sub-acute inflammation, oxidative stress, and microvascular structure/function relationships. PMID:21087503

2010-01-01

419

Hypothermia-induced reversible platelet dysfunction.  

PubMed Central

Baboons that were subjected to systemic hypothermia at 32 C had an arm skin temperature of 27.3 C and bleeding time of 5.8 minutes. With local warming of the arm skin to 34 C, the bleeding time was 2.4 minutes. In normothermic baboons with arm skin temperature of 34.6 C, the bleeding time was 3.1 minutes. Local cooling of the arm skin to 27.6 C produced a bleeding time of 6.9 minutes. Increasing the skin temperature of the arm in hypothermic baboons to 38.9 C and in normothermic baboons to 40.1 C reduced bleeding times to 2.1 and 2.3 minutes, respectively. In both hypothermic and normothermic baboons there was a negative and significant correlation between the bleeding time and the arm skin temperature and the thromboxane B2 level in the shed blood obtained at the template bleeding time site. There was a significant positive correlation between the thromboxane B2 level in the shed blood and the arm skin temperature. Both in-vivo and in-vitro studies have shown that the production of thromboxane B2 by platelets is temperature-dependent, and that a cooling of skin temperature produces a reversible platelet dysfunction. Data also suggest that when a hypothermic patient bleeds without surgical cause, skin and wound temperature should be restored to normal before the administration of blood products that are not only expensive but may also transmit disease. PMID:3813688

Valeri, C R; Feingold, H; Cassidy, G; Ragno, G; Khuri, S; Altschule, M D

1987-01-01

420

Biochemical and genetic markers of erectile dysfunction.  

PubMed

Erectile dysfunction (ED) is a very common pathology, affecting over 150 million men worldwide. The pathogenesis is typically multifactorial, involving a kaleidoscope of organic, endocrine, and psychogenic factors. In general, ED is divided into organic and psychogenic impotence, but most men with organic etiologies have an associated psychogenic component. Given the high frequency of this pathology, the identification of biochemical and genetic correlates and/or markers is of pivotal interest not only for treating preciously these patients and preventing serious psychological consequences but also for the high risk for occult cardiovascular disease (CVD) that often accompanies or follows this pathology. A variety of cardiovascular risk factors have been associated with both the onset and the severity of ED, including markers of endothelial function, thrombosis, and especially dyslipidemia, so that their measurement should now be considered as an important part of the increased global cardiometabolic risk profile in patients with ED. While nitric oxide (NO), asymmetric dimethylarginine (ADMA), and endothelin (ET) hold some promises as biochemical markers of both CVD and ED, there are several technical and clinical drawbacks that make their measurement overall meaningless in the clinical practice. As regards genetic polymorphisms, controversial results have been provided so far. Although some genetic markers were consistently associated with ED, other studies failed to demonstrate significant associations, highlighting a substantial bias in standardization of methodologies and patient enrolment. Nevertheless, further research in this area should be encouraged, since the first promising evidence that gene therapy might be effective to restore the decline in ED has been provided in the animal model. PMID:22870589

Lippi, Giuseppe; Plebani, Mario; Montagnana, Martina; Cervellin, Gianfranco

2012-01-01

421

Profound Olfactory Dysfunction in Myasthenia Gravis  

PubMed Central

In this study we demonstrate that myasthenia gravis, an autoimmune disease strongly identified with deficient acetylcholine receptor transmission at the post-synaptic neuromuscular junction, is accompanied by a profound loss of olfactory function. Twenty-seven MG patients, 27 matched healthy controls, and 11 patients with polymiositis, a disease with peripheral neuromuscular symptoms analogous to myasthenia gravis with no known central nervous system involvement, were tested. All were administered the University of Pennsylvania Smell Identification Test (UPSIT) and the Picture Identification Test (PIT), a test analogous in content and form to the UPSIT designed to control for non-olfactory cognitive confounds. The UPSIT scores of the myasthenia gravis patients were markedly lower than those of the age- and sex-matched normal controls [respective means (SDs)?=?20.15 (6.40) & 35.67 (4.95); p<0.0001], as well as those of the polymiositis patients who scored slightly below the normal range [33.30 (1.42); p<0.0001]. The latter finding, along with direct monitoring of the inhalation of the patients during testing, implies that the MG-related olfactory deficit is unlikely due to difficulties sniffing, per se. All PIT scores were within or near the normal range, although subtle deficits were apparent in both the MG and PM patients, conceivably reflecting influences of mild cognitive impairment. No relationships between performance on the UPSIT and thymectomy, time since diagnosis, type of treatment regimen, or the presence or absence of serum anti-nicotinic or muscarinic antibodies were apparent. Our findings suggest that MG influences olfactory function to the same degree as observed in a number of neurodegenerative diseases in which central nervous system cholinergic dysfunction has been documented. PMID:23082113

Leon-Sarmiento, Fidias E.; Bayona, Edgardo A.; Bayona-Prieto, Jaime; Osman, Allen; Doty, Richard L.

2012-01-01

422

Cognitive dysfunction in postural tachycardia syndrome.  

PubMed

Mental clouding is an almost universal complaint among patients with postural tachycardia syndrome (POTS) but remains poorly understood. Thus, we have determined whether POTS patients exhibit deficits during neuropsychological testing relative to healthy subjects. A comprehensive battery of validated neuropsychological tests was administered to 28 female POTS patients and 24 healthy subjects in a semi-recumbent position. Healthy subjects were matched to POTS patients on age and gender. Selective attention, a primary outcome measure, and cognitive processing speed were reduced in POTS patients compared with healthy subjects (Ruff 2&7 Speed t-score: 40±9 compared with 49±8; P=0.009; Symbol Digit Modalities Test t-score: 45±12 compared with 51±8; P=0.011). Measures of executive function were also lower in POTS patients (Trails B t-score: 46±8 compared with 52±8; P=0.007; Stroop Word Color t-score: 45±10 compared with 56±8; P=0.001), suggesting difficulties in tracking and mental flexibility. Measures of sustained attention, psychomotor speed, memory function or verbal fluency were not significantly different between groups. The present study provides evidence for deficits in selective attention and cognitive processing in patients with POTS, in the seated position when orthostatic stress is minimized. In contrast, other measures of cognitive function, including memory assessments, were not impaired in these patients, suggesting selectivity in these deficits. These findings provide new insight into the profile of cognitive dysfunction in POTS and provide the basis for further studies to identify clinical strategies to better manage the mental clouding associated with this condition. PMID:25001527

Arnold, Amy C; Ha